Application for a Special Circumstances Licence - Consumer and ...
Application for a Special Circumstances Licence - Consumer and ...
Application for a Special Circumstances Licence - Consumer and ...
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Part B cont. – Licensed Premise Details9. Proposed Premises DetailsStreet Number.StreetSuburb/TownPostcodeDaytime telephone numberMobileFaxEmailPart C – Additional In<strong>for</strong>mation10. Plans Two plans of the premises must accompany this application:1) a black <strong>and</strong> white plan2) a plan with relevant colour code outlining designated areas.(refer ‘Submitting Plan - Lodgement Guide)11. Extended TradingAuthorisation Required?(trade between either 8amto 11am AND/OR midnight<strong>and</strong> 2am)12. Entertainment ConsentRequired?(between either 8am to11am AND/OR midnight <strong>and</strong>2am)13. Extension of Trading AreaRequired? (Has an OutdoorDining Permit been Approved bythe relevant Local Council) No Yes (please complete the <strong>Application</strong><strong>for</strong> Extended Trading AuthorisationConsent) No Yes (please complete the <strong>Application</strong><strong>for</strong> Entertainment Consent) No Yes (Please submit copy of Local CouncilPermit)14. On Appendix A, please listthe persons requiringapproval in any of thefollowing categories:LicenseeDirectorShareholderAdult Trust BeneficiaryResponsible PersonPart D – Applicant’s SignatureApplicant SignatureDate / /Print NamePosition/TitleSmall Venue <strong>Licence</strong> <strong>Application</strong> Updated: April 2013 2 of 6
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