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RES 2013-0917 - SDL for beer garden at O July 27, 2013 APPLICATION FOR SPECIAL DESIGNATED LICENSE NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 Website:www.lcc.ne.gov/ DO YOU NEED POSTERS? YESETO VI] RETAIL LICENSE HOLDERS ® NON PROFIT APPLICANTS 0 Non Profit Status(check one that best applies) MunicipalGPolitical Fine Arts°FraternalCeligiousOharitable()Public Service COMPLETE ALL QUESTIONS 1. Type of alcohol to be served and/or consumed: Beer©WineIDistilled Spirits 2. Liquor license number and class(i.e. C-55441) d 1 U (If you're a nonprofit organization leave blank) 3. Licensee name(last, first,), corporate name or limited liability company(LLC)name (As it readson your liquor license) //J NAME: AV C,'1 A)C4- ADDRESS: J 2// //oc.JAtzn St- 0/ CITY /yy j ci ZIP 615/0 ,2, 4. Location where event will be held; name, address, city, county, zip code BUILDING NAME 0 J riva --- i rro .0 ADDRESS: /C/S f=AR,W`}M S?- CITY �/ii+t.4 - ZIP 6' COUNTY and COUNTYI / a. Is this location within the city/village limits? YES 1O❑ b. Is this location within the 150' of church, school,hospital or home for aged/indigent or for veterans and/or wives? YEO c. Is this location within 300' of any university or college campus? YESE11O d FORM 108 REV Jun-13 Page 2 of 5 5. Date(s)and Time(s)of event(no more than six(6)consecutive days on one application) Date Date Date Date Date Date 7 -.27 Hours Hours Hours Hours Hours Hours From From From From From From 5Pw' To To To To To To a. Alternate date: v 1/6 3/3 b. Alternate location: (Alternate date or location must be specified in local approval) 6. Indicate type of activity to be carried on during event: ODance Q Reception 0 Fund Raiser Beer Garden 0 Sampling/Tasting Other 7. Description of area to be licensed Inside building, dimensions of area to be covered IN FEET x , (not square feet or acres) *Outdoor area dimensions of area to be covered IN FEET /4/2 x g v *SKETCH OF OUTDOOR AREA(or attach copy of sketch) (sample sketch) If outdoor area,how will premises be losed? Fence; snow fence [hain link cattle panel other Tent 8. How many attendees do you expect at event? /-2o4. 9. If over 150 attendees. Indicate the steps that will be taken to prevent underage persons from obtaining alcohol beverages. (Attach separate sheet if needed) 4)0 isii"4245 ij21.L 84 hi/,e=✓:zi91 S Gua7rr L CPO tt -ria. ALSO & /sil '/ AT A4E-s s P'wi s 10. Will premises to be covered by license comply with all Nebraska sail' ation laws? YES TO a. Are there separate toilets for both men and women?YES Op u-S cc. Wv, // L,-,/,0 `IT f FORM 108 REV Jun-l3 Page 3 of 5 Q Li5f O ►2.ro.rk(J Our noot 74(1 i5l` / f / tfil 11. Retailer: Will you be purchasing your alcohol from a wholesaler? YES �/ NO Non-Profit: Where will you be purchasing your alcohol? Wholesaler— Retailer Both BYO (includes wineries) 12. Will there be any games of chance operating during the event?YESD1O jj If so, describe activity NOTE:Only games of chance approved by the Department of Revenue,Charitable Gaming Division are permitted. All other forms of gambling are prohibited by State Law: There are no exceptions for Non Profit Organizations or any events raising funds for a charity. This is only an application for a Special Designated License under the Liquor Control Act and is not a gambling permit application. 13. Any other information or requests for exemptions: &E7ZJRN OF 4)005t..0 4.9u0 PIE ato L.TGiuoir i Al 05 Al TIL4 / Asi L.0 uO/.. Mt- _2Ar1 > 14. Name and telephone number/cell phone number of immediate supervisor. This person will be at the location of the event when it occurs, able to answer any questions from Commission and/or law enforcement before and during the event,and who will be responsible for ensuring that any applicable laws, ordinances,rules and regulations are adhered to. PLEASE PRINT LEGIBLY Print name of Event Supervisor J ivic..e_ („)4 Signature of Event Supervisor Event Supervisor phone: Before 170 595O/' 2 During/ 4'l2-s c-O/cs -).- Email address /✓'+N�Gr.�►r:r g.Li4 f�vl;e1e7•!x?inn Consent of Authorized Representative/Applicant �( ✓�/ 15. I declare that I am the authorized representative of the above named license applicant and that the statements made on this application are true to the best of my knowledge and belief. I also consent to an investigation of my background including all records of every kind including police records. I agree to waive any rights or causes of action against the Nebraska Liquor Control Commission, the Nebraska State Patrol or any other individual releasing said information to the Liquor Control Commission or the Nebraska State Patrol. I further declare that the license applied for will not be used by any other person, group, organization or corporation for profit or not for profit and that the event will be supervised by persons directly responsible to the holder of this Special Designated License. sign '1-- here a.,,w-ie G --26'_43 Au epresentative/Applicant Title Date LAbuc4' Aiu ex- Print Name This individual must be listed on the application as an officer or stockholder unless a letter has been filed appointing an individual as the catering manager allowing them to sign all SDL applications. The law requires that no special designated license provided for by this section shall be issued by the Commission without the approval of the local governing body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for which the special designated license is requested is located,or if such place is not within the corporate limits of a city or village,then the local governing body shall be the county within which the place for which the special designated license is requested is located. FORM 108 REV Jun-13 Page 4 of 5 /3 Ze/4 ;) No. 9/9 Wang, Lance, dba "0", 1015 Farnam Street, requests permission for a Special Designated License for a beer garden on July 27, 2013 from 5:00 p.m. to 2:00 a.m. with music until 1:00 a.m. Alternate date: August 3, 2013. 07-02-13;cj , J i RECEIVED Presented to Council: July 2, 2013 - -/(2 '' i ' - I Buster Brown City Clerk