HomeMy WebLinkAbout855 John Fitch Blvd - Permits - Fire Mar . ......
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For Official Use Only I
DCPLC—On-Premises App Rev 1/11 1
STATE OF CONNECTICUT (
DEPARTMENT OF CONSUMER PROTECTION I
Liquor Control Division
Telephone: (860) 713-6210 w2 sly` {
TMN3iu4� #}
Email:liquor.control@ct.gov 1
Web Site: www.ct.gov/dcp .._____..._......___.........._........................__..._................
APPLICATION FOR ON-PREMISES LIQUOR PERMIT
Please print clearly or type the information entered on this application. % prteaoti and perr �ife is �qutred Please
sefee1 �qu[resfee'_ Checks and/or money orders should be made to "Treasurer, State of Connecticut"and
must accompany this application. The application fee is non-refundable. Return your completed application, documentation
and appropriate fee to:
Department of Consumer Protection, License Services Division, 165 Capitol Avenue, Hartford, CT 06106
Section A: BUSINESS INFORMATION
ADDRESS AT WHICH BUSINESS WILL BE CONDUCTED
1. Type of/Liquor Permit Applying for: 2.Are you requesting a Provisional Permit?
B&r i�-- LjlJ YES NO
3.Trade Name(D(( r
BA Name) ' C
4. Business Address City State Zip Code
5.Business Telephone Number 6.Business Fax Number 7.Business Email Address
8. s there currently a liquor permit at the If yes, current permit number 9.Patio?(Ifyes,complete attached patio request form)
proposed premises? ❑YES NO _'
n o Ac ❑YES NO
10.Type of Live Entertainment: ❑YES kj NO (If yes,please check(✓)all that apply below)
❑Acoustics- ❑Disc Jockeys ❑Live Bands ❑Comedians ❑Exotic Dancers
(Not Amplified)
❑Concerts ❑Karaoke ❑Plays/Shows ❑ Sporting Event(s) ❑Magicians
Section B: APPROVAL/CERTIFICATION OF LOCAL OFFICIALS
11. Zoning Authority Approval: I certify that I am familiar with the zoning ordinances and bylaws of the city/town identified in item
#4 of this application and they do not prohibit the sale of alcoholic beverages under the type of liquor permit/establishment identified in
this application and/or entertainment listed in#10.
Signature of Zoning Official X f zlono_J�L 0 QL/ Print Name` }Po mQ.i c, A _Q (t vr—
Title of Official -y-v6 rce; e n ,- Date L1_/ a 4 / Q
12.Fire Marshal's Approval: I certify that the premises identified in items#3 of this application is physically constructed in a
manner that is safe for the type of bus' e�thill be operated there. qq
Signature of Fire Marshal X Print Name 04 C%: �`P_V �tM,wtG✓S
Title of Official i Vle- YAC:Vd,��.� Date /a?��/13
13.Certification of Town Clerk: The town in which the business identified in item#4 of this application is to be operated,has no
ordinance restricting the hours of sale of alcoholic liquors beyond those set forth in State law except as indicated in the box below.
(If none,please enter"NONE")
Additional Restrictions: r\o n`e
Signature of Town Clerk X ��[ ���_ Date ',L_/0?q /�,�