Isis Shrine Temporary Permit 05-03-2022.ALCOHOLIC B EVERAGE CONIROL
109 SW 9th STREET
STATE OF KANSAS
DEPARTMENT OF REVENUE
PHONE: 785-296-7015
P.O. Box3506
TOPEKA KS 66601-3506
FAX: 785-296-7185
www.ksrevenue.org/abc.html
TEMPORARY PERMIT LOCATION AND ZONING
Organization Name or Individual Applicant-'-} 5....,; ... s___,)h'--"f\""'.""'"J_-----------Event Date(s) -S!.Ar-i 1{ J@.
Event Type: 0Charitable Auction Don-Premise 0Porcelain Container ~pecial Event* -Number of Consecutive days (up to 30): __ 1 __ _
*A special event is held on public streets. alleys. roads. sidewalks or highways and must be approved, by ordinance or resolution, by
the local governing body of any city, county or township where such special event is being held.
SECTION 1 -EVENT AREA: Complete this section for On-Premise and Special Events only.
In the space below, in ink, draw the floor plan and any outside areas included in the proposed event area where alcoholic liquor will be sold, served
or consumed. If the area is outside, it must show where the three-dimensional barriers will be located to define the event area; and, include nearby
streets for reference. Shade in the areas you DO NOT wish to be permitted.
:> J_ !!:' ~ ""i..
~ <([__ >
..s;; -'>
6 J..
.;
J_
~ csD-~
':5
3 ..-=Y
= ~ ~ -u
...) ____, _,,..--
«'. ~ J
SECTION 2 -CERTIFICATE OF CITY, TOWNSHIP OR COUNTY CLERK: (completed by the clerk).
I HEREBY CERTIFY THAT THE PREMISES AT 200 e_ D',C.""luadDc S.1ir.,.,,, l,.,211 l) I
Location Street Address City Zip
CITY LIMITS: 181 Inside the incorporated city limits D Outside the city limits
ZONING:~ within an area that complies with all applicable zoning regulations required by K.S.A. 41-2645(d)
D located outside an incorporated city, in a township or county that is not zoned 'Z.o"ad.C-1
LOCATION : 0 government roperty · te pro 0 public property 0 CMB licensed premise
dge and belief that ~eftioy 2 is true, correct and
UE.!~-:!!~~_J~~!b,/;;;'2{5.~k::::_~ DATE ..tj.J/J.:z_ PHONE.~~~L.-,,,1.--f>!-~-
!ilCity Clerk 0Township Clerk 0Cou
ABC-892 08.16.19