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Trade Name(doing business as) 0 h p C r V?ten G o/ <br /> Street Address#1 aaaV 19 Sool 41-vLr Road <br /> Street Address#2 <br /> City et,eahtI TS/d.nri County /.fa / / Zip Code LggJ4 <br /> Premises Telephone number Jog 382- O2o Z <br /> Business e-mail address to i ee/csg(o9 l: G ma, I. do in <br /> Is this location inside the city/village corporate limits: YES NO )14 <br /> Mailing address(where you want to receive mail from the Commission) <br /> Name /N.Cl,.at/ Ptah Z W%eGI1 <br /> Street Address#1 032 w.e.e Slo/%y Prt r/ Rood <br /> Street Address#2 <br /> City A tdc.. State 72j Zip Code d g8VD <br /> c p� <br /> x5[ R t^n ` gys�,f' <br /> " 3 ° sx" 'wf Yhxa , +€.*+ <br /> In the space provided or on an attachment draw the area to be licensed. This should include storage areas,basement, outdoor <br /> area, sales areas and areas where consumption or sales of alcohol will take place. If only a portion of the building is to be <br /> covered by the license,you must still include dimensions(length x width)of the licensed area as well as the dimensions of the <br /> entire building. No blue prints please. Be sure to indicate the direction north and saber of floors of the building. <br /> "For on premises consumption liquor licenses minimum standards must be met by providing at least two restrooms <br /> Building:length 2 q x width t 21/ in feet 'r <br /> Is there a basement? Yes No is If yes,length x width in fat <br /> Is there an outdoor area? Yes sp. No If yes,length j$ x width in feet <br /> PROVIDE DIAGRAM OF AREA TO BE LICENSED BELOW OR ATTACH SEPARATE SHEET <br /> 2724 to),r_Roo.a. <br /> C <br /> L& <br /> tdµ <br /> ` _ Vdn 'etrNl <br /> v -- c" Qt), <br /> FORM 100 i <br /> REV MAY 2015 <br /> PAGE 0 <br />