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APPLICATION FOR TEMPORARY PREMISES <br />EXTENSION FOR LIQUOR LICENSE DUE TO <br />HEALTH PANDEMIC <br />13065 Oiono Paikwav <br />Elk Rivei, NIN 55330 <br />Legal Name of Licensee (individual, business, partnership, c000ration) <br />Establishment Name: <br />Phone:( ) <br />Applicant's Name: <br />First <br />Describe Temporary Premises Extension: <br />Email: <br />Last Middle Maiden <br />Total number of seats outside (including the extension): <br />The following must be attached for the temporary premises extension to be considered: <br />❑ Detailed drawing of proposed premises extension. The extension must be clearly delineated <br />and maintained so include fencing or other barriers (planters, brick, etc) you plan to use to <br />delineate the space. Please use an aerial map if possible. Contact Jessica at 763.635.1004 or <br />p �1lillex i't),�?II;T� i �r�11 J b! if you need assistance in obtaining one. <br />❑ Certificate of Insurance including amended premises <br />❑ Written property owner permission if different than the applicant <br />----------------------------------------------------------------------------------------------------------------------------- <br />I hereby submit application for an Elk Diver liquor license temporary premises extension and attest that all <br />reported information is 1iue and accurate. I am 21 years of age or - older- and am snaking this application <br />pursuant and subject to all the laws of the State of Minnesota and the Elk Diver City Code of Ordinances. I <br />received a copy of the City of Elk Diver City Code Chapter 6 (Alcoholic Beverages) and will familiarz.Ze <br />myself with the provisions contained within them. <br />Applicant's Signature <br />Date <br />