HomeMy WebLinkAboutCannabisBusinessLic formBusiness License & Cannabis Tax Certificate Application
990 Palm Street / P.O. Box 8112 – San Luis Obispo, CA 93403-8112 – (805) 781-7134
Business Name_________________________________________________ Phone_____________________________
Email_________________________________
Website__________________________________________________ Ownership Status: Public
Private
Ownership Type: Corporation Partnership Sole Proprietor Employee Owned Trust Other_________
Business Location _______________________ Suite No._______ City ___________________ State_____ Zip_____
PO Box addresses cannot be accepted as business location
Location Type: Commercial Home Occupation Industrial Residential
Mailing Address ___________________________ Suite No._____ City_____________ State______ Zip__________
Owner/Contact Name______________________________________________________________________________
Federal Employer/Social Security No. ___________________________ State Sales Tax No. _________________
State Franchise No. ___________________________ Business Open Date _________________________________
Bureau of Cannabis Control License No. _____________________________________________________________
NAICS Coding: Please check the category(ies) that best describe your business activity.
Local Messengers and Local Delivery (492210) Other _______________________________________________
Please provide a detailed description of the nature of your business, including products or services offered.
Are you selling or offering the following services or products other than cannabis?
Tobacco Massage Therapy Filming Sales on Streets & Sidewalks Soliciting
Are you doing business from your home? Yes No
Applicant / Representative: I reviewed this application and the information is accurate to the best of my
knowledge. I understand the issuance of a business license & tax certificate does not constitute proof of compliance
with other city, county, state, and federal regulations.
Signed ____________________________________ Title_______________________ Date_______________________
x
Slocal Roots, LLC
slocalroots@gmail.com
www.slocalroots.com x
x LLC
3535 S. Higuera St San Luis Obispo CA 93401
x
3535 S. Higuera St San Luis Obispo CA 93401
Austen Connella
2/14/2022
x
x
C10-0000952-LIC
Other Miscellaneous Store Retailers (459999)
Cannabis Retail storefront selling both Recreational and Medical cannabis products
Owner / CEO 2/16/2022