Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Application For Removal Form. This is a Connecticut form and can be use in Department Of Consumer Protection Statewide.
Loading PDF...
Tags: Application For Removal, Connecticut Statewide, Department Of Consumer Protection
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
LIQUOR CONTROL DIVISION
{Instructions on back}
APPLICATION FOR REMOVAL
1.
NAME AND HOME ADDRESS OF PERMITTEE:
________________________________________________________________________________________________
2.
NAME OF BACKER:
________________________________________________________________________________________________
3.
PERMIT (TYPE & NUMBER):
________________________________________________________________________________________________
4.
PRESENT ADDRESS OF BUSINESS: ________________________________________________________________
(NUMBER)
(STREET)
________________________________________________________________________________________________
(TOWN)
5.
(STATE)
(ZIP)
(TELEPHONE NUMBER)
PROPOSED ADDRESS OF BUSINESS: ________________________________________________________________
(NUMBER)
(STREET)
_________________________________________________________________________________________________
(TOWN)
(STATE)
(ZIP)
6.
HOW MANY FEET IS NEW LOCATION FROM PRESENT PERMIT ADDRESS? _____________________________
7.
IS THE ENTRANCE TO THE PROPOSED NEW LOCATION WITHIN 200 FEET IN A DIRECT LINE FROM A
CHURCH EDIFICE, PUBLIC OR PAROCHIAL SCHOOL? (¥) YES___ NO ___ NAME:_______________________
8.
GIVE APPROXIMATE DISTANCE TO NEAREST CHARITABLE INSTITUTION, WHETHER SUPPORTED BY
PUBLIC OR PRIVATE FUNDS: ______________________________________________________________________
9.
SIGNATURE OF PERMITTEE: ________________________________________________________
10.
SIGNATURE OF BACKER: ___________________________________________________________
11.
IF THIS APPLICATION IS FOR A RESTAURANT, CAFE, TAVERN, HOTEL, CLUB OR THEATER REMOVAL:
THIS PART MUST BE FILLED IN BY THE FIRE MARSHAL IN THE TOWN INDICATED IN ITEM #5.
THIS IS TO CERTIFY THAT PREMISES DESCRIBED IN ITEM #5 ARE PHYSICALLY CONSTITUTED TO
SAFELY CONDUCT THE TYPE OF BUSINESS DESCRIBED IN ITEM #3.
___________________________________________________________________________
FIRE MARSHAL (SIGNATURE & DATE SIGNED)
12.
THIS IS TO CERTIFY THAT I AM ACQUAINTED WITH THE ZONING ORDINANCES AND BY LAWS
OF THE (¥) TOWN____ CITY _____ OR BOROUGH ____ AND THE SALE OF ALCOHOLIC LIQUOR IS
NOT PROHIBITED BY EITHER THE ORDINANCES OR BY LAWS OF SAID TOWN ____ CITY____ OR
BOROUGH____ AT THE LOCATION DESCRIBED IN ITEM #5 OF THIS APPLICATION.
__________________________________________________________________________
ZONING ENFORCEMENT OFFICER (SIGNATURE & DATE SIGNED)
13.
THIS PART TO BE FILLED IN BY THE TOWN, CITY OR BOROUGH CLERK.
THE MUNICIPALITY (¥) HAS ____ HAS NOT____ VOTED OR PASSED AN ORDINANCES TO PERMIT
THE SALE OF ALCOHOLIC LIQUOR ON SUNDAY. HAVE THE HOURS OF SALE HAS BEEN REDUCED
BY VOTE OF CITY____ TOWN____ MEETING OR BY ORDINANCES____?
IF SO, THE REDUCED HOURS ARE______________________________________________.
_____________________________________________________________
CLERK (SIGNATURE & DATE SIGNED)
American LegalNet, Inc.
www.FormsWorkflow.com