ALCOHOLIC BEVERAGE CONTROL
D
EPARTMENT OF REVENUE
109 SW 9
th
STREET
P
HONE: 785-296-7015
F
AX: 785-296-7185
P.O. B
OX 3506
www.ksrevenue.org/abc.html
T
OPEKA
KS 66601-3506
Zoning:
CERTIFICATE OF CITY, TOWNSHIP OR COUNTY CLERK
License Type (applicant check one):
Producer
☐Caterer
☐Hotel/Caterer
☐Microdistillery Packaging/Warehouse
☐Distributor
☐Hotel
☐Non-Beverage User
☐Drinking Establishment
☐Manufacturer
☐Public Venue
☐Drinking Establishment/Caterer
☐Microbrewery
☐Private Club: ☐A or ☐B
☐Farm Winery
☐Microbrewery Packaging/Warehouse
☐Retailer
☐Farm Winery Outlet
☐Microdistillery ☐Packaging/Warehouseing Facility Permit
NOTICE TO CITY/COUNTY CLERK: Submission of this zoning form by the applicant to the City or County constitutes notification to the
governmental entity that an application for a liquor license has been or will be received by the ABC. Should the City or County you represent
desire to make any comments, suggestions or recommendations relative to the granting of or refusal to grant a license to the above-named
applicant; or, the premise for which licensure is sought or to request a hearing pursuant to K.S.A. 41-318 or 41-2608, it may do so by
submitting such comments, suggestions, recommendations or requests to the ABC within 10 days of the date you affix your seal to this
document. You may submit your written request to the address or fax number provided at the top of the form
.
I HEREBY CERTIFY THAT THE PREMISES AT IS:
(Check one box in each section below)
Location Street Address City Zip
CITY LIMITS: ☐ Inside the incorporated city limits ☐ Outside the city limits
County
Retailers only: K.S.A. 41-303 states no license shall be granted to any applicant unless:
1. The board of county commissioners has adopted a resolution approving the issuance of a license to the
location. A certified copy of such resolution must accompany the license application.
ZONING: ☐ within an area that complies with all applicable zoning regulations required by K.S.A. 41-710 or K.S.A. 41-
2608. Farm Wineries, Microbreweries and Microdistilleries must be zoned agricultural, commercial or
business as required by K.S.A. 41-710(b); AND, Retail Liquor Sales, Farm Wineries or Microbreweries
premises must comply with the building regulations required by K.S.A. 41-710.
☐ located outside an incorporated city, in a township or county that is not zoned.
THE CITY/COUNTY ALLOWS: ☐ Basic Hours ☐ Expanded Hours (Sunday sales)
(Seal)
CLERK SIGNATURE ☐ City Clerk ☐ Township Clerk ☐ County Clerk
PRINTED NAME DATE PHONE
☐ I understand that any changes to the approved diagram must be submitted to the ABC and approved prior to making any
change and that this diagram is subject to onsite review by an ABC Enforcement Agent.
☐ I understand that I must maintain a copy of the approved diagram on the licensed premise and make it available for
immediate inspection upon request.
Under penalties of perjury, I declare the information contained in this document a true, accurate and complete disclosure of information.
Licensee Signature Printed Name Date
ABC Office Use Only
☐ DIAGRAM APPROVED AS SUBMITTED
Signature of ABC Official Date
☐ DIAGRAM DENIED
R
eason Denied:
ABC-806 (Rev. 06/19)
Page 3 of 3
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
