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Extenstion Of Use Request Form. This is a Connecticut form and can be use in Department Of Consumer Protection Statewide.
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Tags: Extenstion Of Use Request Form, Connecticut Statewide, Department Of Consumer Protection
DCPLC-ExtensofUseRequestform Rev 10/08
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
Liquor Control Division
Telephone: (860) 713-6210
Fax: (860) 713-7235
Website: http://www.ct.gov/dcp
EXTENSION OF USE REQUEST FORM
PERMITTEE:___________________________________________________PERMIT #_____________________________
BACKER:____________________________________________________________________________________________
ADDRESS:___________________________________________________TOWN__________________________________
TRADE NAME:_______________________________________________________________________________________
BUSINESS PHONE:_____________________FAX #______________________HOME PHONE:_____________________
WILL EXTENSION BE PERMANENT: YES_________ NO____________
If Extension is going to only be used Temporarily, List exact dates needed:________________________________________
DIRECTIONS: ON THE BACK OF THIS SHEET MAKE A SKETCH OF THE EXISTING PERMIT PREMISES
AND INCLUDE THE FOLLOWING
1.
2.
3.
4.
5.
The Extension in relation to the permit premises. List all dimensions of Extension in feet.
All entrances & exits leading to and from the extension.
Portion of sketch that shows Permit Premises must be labeled with all the Dining Rooms, Barrooms, Kitchen, etc
If extension is outside, include property boundaries and height of fencing, if any.
Indicate how alcoholic beverages are going to be served in Extended area. Show all consumer bars &Service Bars
NOTE: If a Consumer Bar is going to be used in the Extension, an application for Additional Consumer Bar permit together
with a $150.00 fee must be Submitted with this application.
IF THIS SHEET IS NOT LARGE ENOUGH, CONTINUE SKETCH ON ONE ADDITIONAL SHEET.
1.
2.
3.
4.
5.
6.
If access to Extension is through the Barroom, the area is considered an extension of the Barroom (NO MINORS ALLOWED)
Unless allowed by Section 30-86(b).
If access to Extension is through a Dining Room, the extension is considered part of the Dining Room.
If Alcoholic Beverages are to be made from a Service Bar in extended area-NO additional fee if required. (Service must be made
by Waitstaff only).
If Alcoholic Beverages are to be made from an Additional Consumer Bar Located in Extension area--area is considered
Barroom-(NO MINORS ALLOWED)
No alcoholic beverages are to leave the extended area (away from premises.)
NO DEVIATIONS FROM THE PLAN SHOWN ON THIS FORM ARE ALLOWED WITHOUT WRITTEN APPROVAL
FROM THIS DEPARTMENT.
SIGNATURE:_______________________________________________________________
PERMITTEE
_________________
DATE
SIGNATURE:_______________________________________________________________
PERMITTEE
_________________
DATE
---------------------------------------------------------------MUNICIPAL APPROVALS
ZONING: SIGNATURE:______________________________________________________________DATE______________________
FIRE DEPT. SIGNATURE:_____________________________________________________________DATE_____________________
HEALTH: SIGNATURE:_______________________________________________________________DATE_____________________
DEPARTMENT OF CONSUMER PROTECTION PATIO APPROVAL
THIS MUST BE DISPLAYED NEXT TO YOUR PERMIT OR PERMIT MUST BE ENDORSED. LIMITATIONS OR CONDITIONS:
APPROVED BY:______________________________________________________________DATE:___________________________
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