HomeMy WebLinkAbout10/17/2022 Item 007 -RECEIVED FOR DLLC USE ONLY OCT 0 5 202Z Arizona Department of Liquor Licenses and Control Date payment received: 800 W Washington 5th Floor Phoenix AZ 85007-2934 www.azliquor.gov CSR initials: (602) 542-5141 APPLICATION FOR EXTENSION OF PREMISES/PATIO PERMIT This application must be returned to the Department of Liquor (Notice:Allow 30-45 days to process permanent change of premises) ❑ Permanent change of area of service. A NON-REFUNDABLE$50 FEE WILL APPLY. Specific purpose for change: ® Temporary change for date(s) of: 11 /11 /20241)rough 11 / 12 /202Zist specific purpose for change: VETERANS DAY 1. Licensee's Name: VETERANS OF FOREIGN WARS POST 6306 Last First Middle 2. Mailing Address: PO BOX 759 Street City State Zip 3. Business Name: VETERANS OF FOREIGN WARgicense # 14080009 4. Business Address: 12858 OATMAN HWY TOPOCK AZ 86436-0759 Street City State Zip 5. Contact phone: (4141 397 5453 Business phone: (92� 768 3033 6. Email: geraldanger@att.net 7. Is extension of premises/patio complete? ❑N/A OYes ❑No If no, what is your estimated completion date? 8. Do you understand Arizona Liquor Laws and Regulations? ®Yes []No 9. Does this extension bring your premises within 300 feet of a church or school? ❑Yes IONo' "rt t:3 t)rtrjA 10. Have you received approved Liquor Law Training? ®Yes El No If yes, when does your Certificate expire? Date: 02 /03 /2025 11. What security precautions will be taken to prevent liquor violations in the extended area? 12. IMPORTANT: ATTACH THE R ISED FLOOR PLAN CoRLY DEPICTING YOUR LICENSED PREMISES AND WHAT YOU PROPOSE TO ADD. 1 1/21/14 Page 1 of 2 Individuals requiring ADA accommodations call (602)542-9027. ❑ Barrier Exemption:an exception to the requirement of barriers surrounding a patio/outdoor serving area may be requested. Barrier exemptions are granted based on public safety, pedestrian traffic,and other factors unique to a licensed premise. List specific reasons for exemption: Investigation Recommendation: ❑Approval []Disapproval by: Date: OBTAIN APPROVAL FROM LOCAL GOVERNING BODY BEFORE SUBMITTING TO THE DEPARTMENTC After completing the application, please take this application to your local Board of Supervisors, City Council or Designate for their recommendation.This recommendation is not binding on the Department of Liquor. is chan in p emises is RECOM ENDED by th local Board of Supervisors, Ci Council or Designate: tym&4 &Ad-, unh..�- (A horized Si ure) ( itle) (Agency) Date l GERALD A ANGER declare that I am the APPLICANT and, under penalty of (Print full name) perjury, making the foregoing application. I have read this application and the contents and all statements are true, correct and complete. X QUARTMASTER 9/30/2022 4143975453 (Si re) Title/Position Date Phone# 3 rzi The foregoing instrument was acknowledged before me this G Oe-A , 2i>z' . Day Month Year State 4 County of N d. kL'N 11 My Commission Expires on:3-,/ 1^ x /(J`.y-. Z-Z— Date ^� 'P Signature of Notary Public Ft puno0 aAmM . C qzo n 4weYY mi'1'-3 _ w .oLs jNwnN uo!Mwwa0 ownd AWW :V3819INWO h::OIOJ f Investigation Recommendation: ❑Approval ❑Disapproval by: Date: Director Signature required for Disapprovals Date: 11/21/14 Page 2 of 2 Individuals requiring ADA accommodations call (602)542-9027. SPECIAL EVENT LICENSED PRFNUSES DLAGRA11 (This diagram must be completed with this application) Special Event Diagram: (Show dimensions, serving areas, and label type of enclosure and security positions) NOTE: Show nearest cross streets, highway, or road if location doesut have an address. NT i `t fm 11, Q i 0 y Si4.v i G