SOCIAL, CULTURAL & COMMUNITY SERVICES
APPLICATION
Record Number:
Version No:
OUTDOOR CAFÉ LICENCE
DCSB-16 FORM 34
File Number:
Issued
Next Review
Pages
4
2014
2017
Page 1 of 3
OUTDOOR CAFÉ APPLICATION FORM
Pursuant to Section 222 of the Local Government Act 1999
Please complete this form and return with a site plan and copy of your public liability insurance
to: District Council of Streaky Bay
PO Box 179
Streaky Bay SA 5680
APPLICANT
NAME OF BUSINESS OR COMPANY
NAME OF PROPRIETOR OR DIRECTOR
ADDRESS OF THE BUSINESS
CONTACT PHONE NUMBER
ASSESSMENT NO.
TITLE
REFERENCE
NUMBER OF
TABLES
NUMBER OF SEATING
POSITIONS
HOURS OF
OPERATION
(FOR BENCH SEATS 45CM= 1 SEAT)
Is the area Licensed under the Liquor Licensing Act? If so please attach a copy of actual licensed area.
Also attach a copy of current liquor licence.
Please circle
YES /
NO
I have read and agree with the terms and conditions listed in this application form.
Signed:
Name:
Date:
Electronic Version is the controlled version. Printed copies are considered uncontrolled. Before using a printed copy, verify that it is the
current version
Page 1 of 3
SOCIAL, CULTURAL & COMMUNITY SERVICES
APPLICATION
OUTDOOR CAFÉ LICENCE
DCSB-16 FORM 34
File Number:
Record Number:
Version No:
Issued
Next Review
Pages
4
2014
2017
Page 2 of 3
PLANS
All applications must include a plan/s with the following details:

















An outline of the premises associated with the dining area with correct dimensions of the footpath
area and the proposed footpath dining area.
A basic outline of adjoining buildings or tenancies and their uses.
The location of entries and exits to the premises associated with the dining area.
The location of entries and exits of adjoining building or tenancies.
The property boundary.
The footpath, kerb and channel.
All existing street furniture, trees, garden beds, artwork, planter boxes, posts, street signs, parking
signs, and the like, within, and in proximity to, the proposed dining area.
All service pit lids, transformers, and the like, within, and in proximity to, the proposed dining area.
Details of the kerbside parking uses (metered parking, loading zones, etc.) that adjoin or are in
proximity to the proposed dining area.
The location of the roadway intersections, side roads, driveways or pedestrian crossings within, an
in proximity to, the proposed dining area (refer to design guidelines section).
A dimensioned outline of the area within the footpath intended for use as a dining area.
Dimensioned pedestrian access corridors adjoining the dining area.
Dimensions identifying the distance of the dining area from the face of the kerb.
Dimensions identifying the distance of the dining area from existing fixtures in the footpath such as
tree grates, street furniture, etc.
Dimensions identifying that the dining area does not impact on the kerbside parking uses.
The proposed position of all tables, chairs, planter boxes, wind breaks, umbrellas, awnings, etc
proposed within the dining area.
Details and dimensions of the proposed tables, planter boxes, awnings, umbrellas and wind breaks.
A copy of the Applicants Public Liability Insurance for $10,000,000 needs to be supplied at the time of
making an application.
A copy of Liquor Licence for the sale of alcohol needs to be provided for licensed premises.
Details of any structure or furniture which will be placed in the Licensed area including details about
how it will be affixed to the ground.
Electronic Version is the controlled version. Printed copies are considered uncontrolled. Before using a printed copy, verify that it is the
current version
Page 2 of 3
SOCIAL, CULTURAL & COMMUNITY SERVICES
APPLICATION
OUTDOOR CAFÉ LICENCE
DCSB-16 FORM 34
File Number:
Record Number:
Version No:
Issued
Next Review
Pages
4
2014
2017
Page 3 of 3
Site Plan of Outdoor Café Dining Area
Electronic Version is the controlled version. Printed copies are considered uncontrolled. Before using a printed copy, verify that it is the
current version
Page 3 of 3