Fillable Form 8916 (City of Lebanon)

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Form 8916 (City of Lebanon)

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CITY OF LEBANON N.H.—Applications & Permits
Lebanon City Manager’s Office:
Physical address: 20 West Park Street
Lebanon, NH 03766
Mailing address: 51 North Park Street
Lebanon, NH 03766
Email: manager@lebanonnh.gov
Phone: 603-448-4220
Lebanon City Hall offices are closed to the public until further notice. All City Department staff will be available to
answer questions via phone or email.
The City of Lebanon continues to accept applications and permits via email, through the mail or dropped into the
green mailbox outside of the entrance to 20 West Park Street. Application and permit information can be found
on our website here:
https://lebanonnh.gov/203/Applications-Permits
All permits issued for the 2020 calendar year will remain in effect at this time, but with the rapidly evolving
circumstances regarding COVID-19, these may be rescinded. You will be notified at the earliest possible time for
you to plan accordingly.
The City of Lebanon is actively engaged with the New Hampshire Department of Health and Human Services
(DHHS) and our local and regional partners with regards to State and local response to the COVID-19 virus.
We encourage all to visit our website for the latest updates and information:
https://lebanonnh.gov/1350/COVID-19
City of Lebanon
Exemption to Allow Alcohol on City Property
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EXEMPTION TO ALLOW ALCOHOL ON CITY PROPERTY
City of Lebanon
Exemption to Allow Alcohol on City Property
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CITY OF LEBANON N.H.
(IN ACCORDANCE WITH CITY CODE §14-5)
The purpose of this article is to regulate and control the consumption and possession of alcoholic
beverages in certain places. The authority for this article is RSA 47:1 and RSA 47:17.
EXEMPTION TO ALLOW ALCOHOL ON CITY PROPERTY
NAME:
ORGANIZATION:
ADDRESS:
PHONE: EMAIL:
EVENT INFORMATION
DATE: START TIME: END TIME:
LOCATION:
PURPOSE:
TYPE OF EXEMPTION REQUESTED
Consumption of Alcohol Sale of Alcohol* Both Consumption/Sale
*For the sale of alcohol, please attach a copy of your New Hampshire Liquor License.
Please provide the name and phone number of the person (over the age of 21) designated to remain
substance-free and to monitor the event for appropriate alcohol consumption by attendees.
Name: Phone/Cell #:
Please provide the names and phone numbers of two (2) designated drivers who will not consume alcohol,
and will be available until the end of the event.
Name: Phone/Cell #:
Name: Phone/Cell #:
CONDITIONS OF USE:
The exemption time period shall not exceed 12 hours.
Alcohol will be served only pursuant to State and Federal Laws regulating the distribution and
consumption of alcohol.
Please have a copy of the NH Liquor License in your possession the day of your event.
FOR OFFICE USE ONLY
DATE RECEIVED: PERMIT #
Monitors Name Provided
Designated Drivers Names Provided
NH Liquor License Provided
Police Chief Approval:
Date Received:
FINAL APPROVAL:
CITY MANAGER: Date:
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Form 8916 (City of Lebanon)

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Completed 14 July 2020

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