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SCC Alcohol Permanent Premise ApplicationALCOHOLIC BEVERAGE CONTROL 109 SW 9th STREET P.O. Box 3506 TOPEKA KS 66601-3506 Zoning: DEPARTMENT OF REVENUE PHONE: 785-296-7015 FAX: 785-296-7185 www .ksrevenue.gov/abc.html CERTIFICATE OF CITY, TOWNSHIP OR COUNTY CLERK License Type (applicant check one): OProducer DCaterer DDistributor D Hotel/Caterer DHotel D Microdistillery Packaging/Warehouse D Non-Beverage User 'Jiij)rinking Establishment D Manufacturer D Microbrewery D Public Venue D Drinking Establishment/Caterer DFarm Winery DFarm Winery Outlet D Microbrewery Packaging/Warehouse D Microdistillery D Private Club: DA or DB DRetailer OPackaging/Warehouseing Facility Permit NOTICE TO CITY/COUNTY CLERK: Submission of this zoning form by the applicant to the City or County constitutes notification to the governmental entity that an application for a liquor license has been or will be received by the ABC. Should the City or County you represent desire to make any comments, suggestions or recommendations relative to the granting of or refusal to grant a license to the above-named applicant; or, the premise for which licensure is sought or to request a hearing pursuant to K.S.A. 41-318 or 41-2608, it may do so by submitting such comments, suggestions, recommendations or requests to the ABC within 10 days of the date you affix your seal to this document. You may submit your written request to the address or fax number provided at the top of the form . (Check one box in each section below) CITY LIMITS: ~Inside the incorporated city limits D Outside the city limits County Retailers only: K.S.A. 41-303 states no license shall be granted to any applicant unless: ZONING: 1. The board of county commissioners has adopted a resolution approving the issuance of a license to the location. A certified copy of such resolution must accompany the license application. 'r/... within an area that complies with all applicable zoning regulations required by K.S.A. 41-710 or K.S.A. 41- 2608. Farm Wineries, Microbreweries and Microdistilleries must b~ zoned agricultural, commercial or business as required by K.S.A. 41-710(b); AND, Retail Liquor Sales, Farm Wineries or Microbreweries premises must comply with the building regulations required by K.S.A. 41-710. "l..C)V\&A. A· l D located outside an incorporated city, in a township or county that is not zoned. "DA THE CITY/COUNTY ALLOWS: D Basic Hours ~Expanded Hours (Sunday sales) ~\\(' OF?~ L, <:) ••"''••. '4(/ ~ .. ··· ·· ... ~,, /..;:. / oRGAN/Z£o -...-? ~ i (Seal) i ~ .J. !. 1870 i > ~ ·.. -·-.··~) -City Clerk D Tow 1~ie01'k0.4l-'>Oti~ I DATE J/2(/22.. PH ~I understand that any changes to the approved diagram must be submitted to the ABC and approved prior to making any change and that this diagram is subject to onsite review by an ABC Enforcement Agent. 'yl1 understand that I must maintain a copy of the approved diagram on the licensed premise and make it available for immediate inspection upon request. Under penalties of perjury, I declare the Information contained In this document a true, accurate and complete disclosure of Information. ga• ~llfilll ~MM£l)D 3j 11 1 ~ ABC Office Use Only D DIAGRAM APPROVED AS SUBMITTED Signature of ABC Official Date D DIAGRAM DENIED Reason Denied: ABC-806 (Rev. 06/19) Page 3 of 3 ALCOHOLIC B EVERAGE CONTROL 109 SW 9th STREET P.O. Box 3506 TOPEKA KS 66601-3506 D EPARTMENT OF REVENUE PHONE: 785-296-7015 FAX: 785-296-7185 www.ksrevenue.gov/abc.html REQUEST FOR PERMANENT PREMISE APPROVAL Check one: ~ew License Application D Permanent Change to Premise Dlocation Change -Required ABC-22 and a copy of your lease or deed are attached. Licensee Information C~t::i~t Phone Person l..X\v\-S \c I am applying for or have a Retailer, Farm Winery, Microbrewery or Microdistillery license. If yes, is the premise at least 200 feet from a school, college or church? Diagram: Check the appropriate box then draw a complete diagram of the premises for which you are seeking approval or attach your drawing. The diagram must include all entrances, exits and interior doors, walls, coolers, bars, liquor storage space, kitchen, counters, sales areas, office, restrooms, etc. Architectural drawings will not be accepted. Return the completed form to the address above. Check one: Diagram drawn below D 8~" X 11 " drawing attached ABC-806 (Rev. 06/19) \ ~c.,/~q< (ii ·• \ ·~ - j·~~-1-~ ' I (, -- Page 2 of 3 .ALCOHOLIC BEVERAGE CONTROL 109 SW 9th STREET P.O. Box 3506 TOPEKA KS 66601-3506 DEPARTMENT OF REVENUE PHONE: 785-296-7015 FAX: 785-296-7185 www.ksrevenue.gov/abc.html REQUEST FOR PERMANENT PREMISE APPROVAL Check one: ~ew License Application D Permanent Change to Premise Dlocation Change -Required ABC-22 and a copy of your lease or deed are attached. Licensee Information License Number (New License Applicant -enter your FEIN) (el Phone Number Ct> 11 d. 6..Lc...o I am applying for or have a Retailer, Farm Winery, Microbrewery or Microdistillery license. If yes, is the premise at least 200 feet from a school, college or church? D Yes Diagram: Check the appropriate box then draw a complete diagram of the premises for which you are seeking approval or attach your drawing. The diagram must include all entrances, exits and interior doors, walls, coolers, bars, liquor storage space, kitchen, counters, sales areas, office, restrooms, etc. Architectural drawings will not be accepted. Return the completed form to the address above. Check one: ..Moiagram drawn below 08~" X 11" drawing attached ----- ABC-806 (Rev. 06/19) Page 2 of 3