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SOUTH LAKELAND DISTRICT COUNCIL Public Health & Licensing Group, South Lakeland House, Lowther Street,
Kendal, Cumbria LA9 4UD Tel: 0845 050 4434 Fax: (01539) 740300
www.southlakeland.gov.uk e-mail: [email protected]
Application for a premises licence to be granted under the Licensing Act 2003
PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST
Before completing this form please read the guidance notes at the end of the form. If you are completing this form by hand please write legibly in block capitals. In all cases ensure that your answers are inside the boxes and written in black ink. Use additional sheets if necessary.
You may wish to keep a copy of the completed form for your records.
I/We . ~.t\~.,.'-c-<"1'~~ .. Co~.C1G: .....Lm.....L/f'i.::, Tt1.f:..½MU~·S....Js-\-~, (Insert name(s) of applicant)
apply for a premises licence under section 17 of the Licensing Act 2003 for the premises described in Part 1 below (the premises) and I/we are making this application to you as the relevant licensing authority in accordance with section 12 of the Licensing Act 2003
Part 1 PremIses DetaI·1s- r South' ' ·~·
Postal address of premises or, if none, ordnance survey map refen ~ce or d~r:fi'rotection__,, cit
·-n-1e ~ Prfs.1._e ~ 0 -~ JUN 2013 Con?Stuf\.__ 12b A1-fi3,L C::- S. \ D L=-
C u ,r:cs ~ i -f\
Post town I Pl \'YI°2,U?·"'= \ D Ge I Postcode I LAl J_ °'~' . Telephone number at premises (if any) 01 S :":. 9 4- 3,3,"l.-=\1-
Non-domestic rateable value of premises £ I~ '2__ "'S"Q
n"!::Cejpr No Part 2 - Applicant Details Initials
OOhuo,00000000000040
•••••000000000600
Please state whether you are applying for a premises licence as Date Please tick as appropriaie'"""""""••..... ,. ............ .
oeoooo
a) an individual or individuals * please complete section (A)□ b) a person other than an individual *
i. as a limited company ~ please complete section (B)
ii. as a partnership please complete section (8)□ iii. as an unincorporated association or please complete section (8)□
October 2012
iv. other (for example a statutory corporation) please complete section (B)□ c) a recognised club please complete section (B)□ d) a charity please complete section (B)□ e) the proprietor of an educational establishment please complete section (B)□ f) a health service body please complete section (B)□ g) a person who is registered under Part 2 of the please complete section (B)□
Care Standards Act 2000 (c14) in respect of an independent hospital in Wales
ga) a person who is registered under Chapter 2 of please complete section (B) □Part 1 of the Health and Social Care Act 2008 (within the meaning of that Part) in an independent hospital in England
h) the chief officer of police of a police force in please complete section (B) □England and Wales
* If you are applying as a person described in (a) or (b) please confirm:
Please tick yes
I am carrying on or proposing to carry on a business which involves the use of the D premises for licensable activities; or
I am making the application pursuant to a
statutory function or □ a function discharged by virtue of Her Majesty's prerogative □
(A) INDIVIDUAL APPLICANTS (fill in as applicable)
Other Title (for Mr Mrs Miss Ms□ □ □ □ example, Rev)
Surname First names
I am 18 years old or over Please tick yes □
Current postal address if different from premises address
Post town I PostcodeI I Daytime contact telephone number I E-mail address (optional)
October 2012
SECOND INDIVIDUAL APPLICANT (if applicable)
Mr D Mrs D Miss D Ms D Other Title (for example, Rev)
Surname First names
I am 18 years old or over D Please tick yes
Current postal address if different from premises address
Post town I PostcodeI I Daytime contact telephone number I E-mail address (optional)
(8) OTHER APPLICANTS
Please provide name and registered address of applicant in full. Where appropriate please give any registered number. In the case of a partnership or other joint venture (other than a body corporate), please give the name and address of each party concerned.
Name s ~-J t,..__ ~\...J'S.+( -+ HA-QIL- ~I..J.'::-,\-+--
Address
Registered number (where applicable)
Sbo62s'8
Description of applicant (for example, partnership, company, unincorporated association etc.)
Lib CC>'°IY~-'--(.
Telephone number (if any)
E-mail address (optional) .
October 2012
Part 3 Operating Schedule
DD MM YYYYWhen do you want the premises licence to start? lol 1~k,l-c\cl1:.10I 1~11-1 -
If you wish the licence to be valid only for a limited period, when do DD MM YYYY you want it to end? I ~1 ~1 ~1 ~1 ~1 ~1 ~1 ~1
Please give a general description of the premises (please read guidance note 1)
-f'ouP~<E&-/\- -~bC'.aa\-\ ½ UE'~l¼C>O::.-.&
E-t::"c-11:: o<;=: A-;--rB.Le:s. , b C:- G ._.-<=:-2 l- 0 c, ic_ i t---- c, l'c;,c, u.-=:, [_ I /-- C, ~ (':'2:E-{I.__ - A -:S.H A1-L- ~e:s----=.1 bC---;\.._<S,_
L D l_'.) L C:--1 ~ I ~ A L ~ ~A \ L t-'rts.L G-- fa~ \.__'.)~(_-
If 5,000 or more people are expected to attend the premises at any one time, please state the number expected to attend.
What licensable activities do you intend to carry on from the premises?
(Please see sections 1 and 14 of the Licensing Act 2003 and Schedules 1 and 2 to the Licensing Act 2003)
Please tick any that Provision of regulated entertainment
apply
a) plays (if ticking yes, fill in box A) D
b) films (if ticking yes, fill in box B) D
c) indoor sporting events (if ticking yes, fill in box C) D
d) boxing or wrestling entertainment (if ticking yes, fill in box D) D
e) live music (if ticking yes, fill in box E) D
f) recorded music (if ticking yes, fill in box F) D
g) performances of dance (if ticking yes, fill in box G) D anything of a similar description to that falling within (e), (f) or (g)
h) D(if ticking yes, fill in box H)
DProvision of late night refreshment (if ticking yes, fill in box I)
Supply of alcohol (if ticking yes, fill in box J) d In all cases complete boxes K, Land M
October 2012
J
Supply of alcohol Will the SUE
-------------
----------------
L
K
Please highlight any adult entertainment or services, activities, other entertainment or matters ancillary to the use of the premises that may give rise to concern in respect of children (please read guidance note 8).
Hours premises are State any seasonal variations (please read guidance note 4) open to the public Standard days and timings (please read guidance note 6)
Day Start Finish
Mon p{2_ Crvi ( S' ,:;._> ~NL'( 0PCN ................
......-;---10 (2-~ I t, cY\,7) 0tJ L'/
Tue ...........
Wvro ~ L--- ~'cT-r-1 Ov2r2-N t Cri-r; ~ Wed
------------···· Non standard timings. Where you intend the 12remises to be 012en to the (!Ublic at different times from those listed in the
Thur column on the left. (!lease list (please read guidance note 5) ........
Fri
Sat ···········-----
Sun
October 2012
M Describe the steps you intend to take to promote the four licensing objectives:
a General - all four licensing objectives {b, c, d and e) (please read guidance note 9)
lsC ,4- ✓f\11--~-&lL h'WM QCC,,-c..,>i70rJ ~ yLC.OH-OL-- vJ11..-1..- (),H-'I
i!,,r,n.-~ () F W, /\l c <Z-- 1?,i:7:---n._ j:::"o 12-- furJs.u M Pr!Or./ ( l"I (Z. ~ 1{) t.- TS
j2.oOf¼':> 0-ll.- C-u p,,-,...100<7'-'- LovNen:;.. Prn-e.'Y-t. P-<iDl-£ fA)1(._1--
(;.v,A-r,JL,,C y-\.isC A 1/!,Prl1- (H2..£'AI Pr-fv't:, NJ Mo.-vc>/ \;J IL-L-
O,,r, , ,Xl 1/C>'l,-'I (.__ , ,n.E OPP012.-·,v i T'-/(J1')--;-. l--- A ~--;-- 0-,-( [' gll.l,((,. 0 (L
N OT AvA- / (_,/H> i.-C: LO (h-__--yv ~ -() -J /3. L \ (_,(-'0 12..- (.,a..( IV\ z:, (-h..c,o 1-\0 L-
No,- '5.E A-,v ( s;, v [ ,,J 02 lg 1 · /3,l- "'-- NU 1',,{t-NU)i: S:.,1ou v
b The revention of crime and disorder
S, N4 W8 A-a.CC: NOT
~H.Du~ [\.i'o, 1"bC: A-iv l;;,~u[ w1 1.- 1-- 8 £ ND Ci-- I,~ ~,1,-1?r2,.,£'\0 fvlC::: C,--c_'7\/E.: {U-\1_. /)u(!;,L--1 C- ,
gz_ Of\.! b IS, LA '-lWt L---L-- N0-1OF 'Dt ~'T '9,, ,.JC. £ R-z__ C.0 ir\ 0 L--
~ U p,/ Go rJ ~ U ,'VI tv Lr A,(0 I> 'TH,,.."Y2.-i \.-\..l1 c.--L i3 .;:_ No 1U't rz__ c_,£
~HOL-
cl Public safetv
r\J '2.-- CAr ""' ~ , !'I Ir \::>12- \ N 1,(.1 VV Lr--Z...()ri ir'I fL_ O;, 1 b C'r" ·0
Ht,,C,.L; 1,t01..-- l.v ·n-1€11'- (2.oo{vt Q{2__ lo u {\j v£ Ai2_ iY\ ,
di The Drevention of oublic nuisance
----: s"" _r\V\C, l<-C,- ls.
el The Drotection of children from harm
wi:- 0rJL'( ~lr-w[ 'IWQ 1~1L'-/ (2o0M>, vJ[: iJ19V1.,,))
~M~ f2011)8'JD W111--l ct,itL-DRt-"lv Wl,{o ~u/i..-vt;\As.~
Pr S,, MI L-A-rL (vl/-HV I\J e-"1L I(Ai-w vl oL- to &ch PrVc t0
LJ [,-j €Y'J n-c E::'-l A-a-~ A--, f--l oil\/1 £ Q-N ~ [;><- ~ rz._ c.. d, t: 'D-k -
SR-r-vt[ i)u<'i Or ~ to fl,{~r(L lvicL,~~
Checklist:
October 2012
Please tick to indicate agreement
~• I have made or enclosed payment of the fee.
J:Y• I have enclosed the plan of the premises.
• I have sent copies of this application and the plan to responsible authorities and v--others where applicable.
I have enclosed the consent form completed by the individual I wish to be designated•
premises supervisor, if applicable.
I understand that I must now advertise my application.• I understand that if I do not comply with the above requirements my application will be
• rejected.
IT IS AN OFFENCE, LIABLE ON SUMMARY CONVICTION TO A FINE NOT EXCEEDING
LEVEL 5 ON THE STANDARD SCALE, UNDER SECTION 158 OF THE LICENSING ACT
2003, TO MAKE A FALSE STATEMENT IN OR IN CONNECTION WITH THIS APPLICATION.
Part 4 - Signatures (please read guidance note 10)
Signature of applicant or applicant's solicitor or other duly authorised agent (see guidance
note 11 ). If signing on behalf of the applicant, please state in what capacity.
Signature
Date S \· S- \ ~
Capacity b , rec.-\-c), ·
For joint applications, signature of 2nd applicant or 2nd applicant's solicitor or other
authorised agent (please read guidance note 12). If signing on behalf of the applicant,
please state in what capacity.
Signature
Date ':) \ ·- ~ - ( }
Capacity
Contact name (where not previously given) and postal address for correspondence associated
with this application (please read guidance note 13)
I Postcode IPost town I Telephone number (if any) I If you would prefer us to correspond with you by e-mail , your e-mail address (optional)
Notes for Guidance
October 2012
1. Describe the premises, for example the type of premises, its general situation and layoutand any other information which could be relevant to the licensing objectives. Where yourapplication includes off-supplies of alcohol and you intend to provide a place forconsumption of these off-supplies, you must include a description of where the place willbe and its proximity to the premises.
2. Where taking place in a building or other structure please tick as appropriate (indoorsmay include a tent).
3. For example the type of activity to be authorised, if not already stated, and give relevantfurther details, for example (but not exclusively) whether or not music will be amplified orunamplified.
4. For example (but not exclusively), where the activity will occur on additional days duringthe summer months.
5. For example (but not exclusively), where you wish the activity to go on longer on aparticular day e.g. Christmas Eve.
6. Please give timings in 24 hour clock (e.g. 16:00) and only give details for the days of theweek when you intend the premises to be used for the activity.
7. If you wish people to be able to consume alcohol on the premises, please tick 'on thepremises'. If you wish people to be able to purchase alcohol to consume away from thepremises, please tick 'off the premises'. If you wish people to be able to do both, pleasetick 'both'.
8. Please give information about anything intended to occur at the premises or ancillary tothe use of the premises which may give rise to concern in respect of children, regardlessof whether you intend children to have access to the premises, for example (but notexclusively) nudity or semi-nudity, films for restricted age groups or the presence ofgaming machines.
9. Please list here steps you will take to promote all four licensing objectives together.10. The application form must be signed.11. An applicant's agent (for example solicitor) may sign the form on their behalf provided
that they have actual authority to do so.12. Where there is more than one applicant, each of the applicant or their respective agent
must sign the application form.13. This is the address which we shall use to correspond with you about this application.
October 2012
IHl.:U:. t:.1-.::i/ t:.1-.::i
SOUTH LJUmLAND DISTRICT COUNCIL SOUTH LAKl;~ANf,I
Licensing Section, South Lakeland Hous@, Lowlh~r SlrNI, K1Nldal, Cumbria, LA9 4UD OISTRICT COUNOLr.,,, (Oi639) 733333 Ext 1,.g117484 ~~x, (01539) 737669
e.-mail: §cen!iingGl,-puthlmland.gov.uk
Part A
Consent of individual to being specified ii$ premises supervisor
I....::S.\-;1.€\~~Lk.........\,;!. . .,.;;,~-\....:.......ffull name oferospective premises supervisor) of....!..,\;' ...... ........ ...: ................... (home fldd= ofprospective premises supervisor) hereby confirm that I giv"' rny consent to be specified as the designated premises supervisor In relation to the application for..f~i.u:.,.,£;;:<:,..L.ceUjtype ofapplication) by ...:S,r.1.~.u...A.s.....Ccn:ac..e:,......LT.t;::..:.............................[name of applicant] relating to a premises li~ence ....................................[number ofeximng /icenc:e, ifa_n.y] for.::::t::tt!a. ....Q.~Gc.:.........ei.w.£s...T.t-!..au~...1-.~·~-:n:::i~..~ A:t1.B~\l;£;;..... [name and address ofpremises to which the application relates] and any premises licence to be granted or varied in respect of this application made by ...........Z::.1:¼£!.L~..'5... ..... coue..c.i.e-,......i.::w................(name ofapplicant] concerning the S\!(>ply of alcohol at::nifu..C-t~.~....c...0.E':~O.w.~ COr:1.~L.£.D.......(name and addre5s ofpremises to which application relates]. I also confirm that I am applying for, intend to apply for or currently hold a personal licence, details of which I set out below.
Personal licence number .f:':19..0.2.2.L........-[insert personal licence number. ifany] Personal licence issuing authority ......~..b~.C...:.......................................................... [insert name and address and telephone number ofpersonal licence issuing authority, if any)
..3.f?.s..:i.~..:........signed
.....~ .....iZ,.s.:i!:...\:! ....... name (please print)
...~ ..:...b..:...1..3!.........-dated
PARTB
Consent of premlse5 licence holder to transfer
I/we ....................................................................1/ull name ofpremises licence holder(s)] the premises licence holder of premises licence number ............................. [insen premises licence number) relating to ................................................................................... . .......................... ,-·--·~·············-···· .. ••n.. ••·························· ...................(name atld address of premises to which the application relates] hereby give my consent for the transfer of premises licence number .............................................[insert premises licence number] to .......................................................................................[full name oftransferee).
.........................................signed
........... ,.,H............... ,~........name (please print]
........................................ dated
1
••
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