Application for a Special Circumstances Licence - Consumer and ...

More documents

Recommendations

Info

Part B cont. – Licensed Premise Details9. Proposed Premises DetailsStreet Number.StreetSuburb/TownPostcodeDaytime telephone numberMobileFaxEmailPart C – Additional Information10. Plans Two plans of the premises must accompany this application:1) a black and 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 midnightand 2am)12. Entertainment ConsentRequired?(between either 8am to11am AND/OR midnight and2am)13. Extension of Trading AreaRequired? (Has an OutdoorDining Permit been Approved bythe relevant Local Council) No Yes (please complete the Applicationfor Extended Trading AuthorisationConsent) No Yes (please complete the Applicationfor 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 Licence Application Updated: April 2013 2 of 6
Special Circumstances Licence Application22. Details of condition(s)sought(Attach separate sheet ifnecessary)23. On Appendix A, please list the persons requiring approval in any of the following categories:DirectorShareholderAdult Trust BeneficiaryResponsible PersonLicenseeFor assistance refer to ‘Licensees, Directors and Shareholders Liquor Licensing Act, 1997 - Lodgement Guide’(Please photocopy if there is not enough space)3 of 5
Page 1: Special Circumstances Licence Appli

Application for a Special Circumstances Licence - Consumer and ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?