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2. First Name*
3. Last Name*
5. Business Name*
6. City Liquor License Number
8. Phone Number*
9. Fax Number
11. Email Address
13. Address*
15. City*
16. State*
17. Zip Code*
19. Upload Site Plan.*
    Upload site plan showing the location of the outdoor service area in relation to the main building of the business location for which the license holder current has a valid liquor license, the location of all barriers that will create the outside perimeter of the outdoor service area, the type of barrier that will be used to create the perimeter barrier, the number and location of all tables within the outdoor service areas with seating capacity for each table, and all means of ingress and egress into the outdoor service area. Site plan must show the maximum dimensions (in feet) for the perimeter of the outdoor area.
21. Certification and Acknowledgements.*

    1. I certify and acknowledge that I understand the provisions of this Special Permit and will follow all regulations related to the Special Permit.
    2. I certify and acknowledge that I will check and comply with all State, County, and other regulations related to the Special Permit.
    3. I certify and acknowledge that I will check and comply with dram shop insurance regulations related to the Special Permit.
    4. I certify and acknowledge that the outdoor service area is constructed on the property owned or leased by the business providing the outdoor service of food or beverage.
    5. I certify and acknowledge that I must provide documentary evidence that the business owner has a legal right to use the property for providing the outdoor service of food or beverage serve.
    6. I acknowledge that I will comply with all directives provided by a member of the East Peoria Fire Dept or East Peoria Police Dept regarding the location, set up, & layout of the outdoor service area.
23. Signed (Print Name)*
24. Date*
    Date

    Date
26. City of East Peoria Temporary Restaurant & Bar Outdoor Space Guidance
    City of East Peoria Temporary Restaurant & Bar Outdoor Space Guidance
28. Resolution Number 2021-011
    Resolution Number 2021-011 - Resolution Establishing Parameters For Outdoor Service By Restaurants and Liquor License Holders
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30. 1. Receive an email copy of this form.
31. Email address

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32. Submit

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