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<br />DEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI‘I <br />Hilo Lagoon Centre, 101 Aupuni St., Unit 230, Hilo, Hawai‘i 96720 *Phone:(808)961-8218 *Fax:(808)961-8684 <br />E-Mail: cohdlc@co.hawaii.hi.us <br />STATEMENTS OF OPERATIONS <br />APPLICANT: dba: <br />PROPOSED HOURS: TO _____ <br />OPEN HOW MANY DAYS A WEEK: ______________ DAY(S) CLOSED: <br />TOTAL EMPLOYEES: NO. OF LIQUOR CARD HOLDERS: <br />(Persons who will take the liquor law examination) <br />RESTROOMS: <br />Ifliquor is consumed on premises, must have separate facilities for males and females. <br />LOCATION OF EMPLOYEE RECORDS: <br />LOCATION OF FINANCIAL RECORDS: <br />Provide accountant’s information if you want your “Gross Liquor Sales Report”formsent directly to your <br />accountantto complete. (Liquor sales report due on or before July 31 and January 31.) <br />Name: <br />Address: <br />RETAIL STORES ONLY: CHECK ITEMS THAT APPLY TO YOU <br />GAS <br />HOT FOODS <br />BENTOS <br />DELIVERY SERVICE <br />OFF SITE LIQUOR STORAGE <br />ON PREMISES CONSUMPTION ONLY: CHECK ITEMS THAT APPLY TO YOU <br />(Bars, Restaurants, Hotels, Clubs, Vessels – Preparation of all drinks shall be conducted at a service <br />bar that will permit any interested customer to view the bartender’s operation.) <br />Food: Kind of Cuisine _____________________________________________ <br />Breakfast/Times ________ Lunch/Times_______Dinner/Times__________ <br />Live Entertainment:SoloistBand DJ Shows/Live performances <br />Circle days of week: SU M T W TH F SA <br />In house speaker system Bandwill bring own system <br /> Karaoke Hip Hop/Reggae <br /> Rock Hawaiian <br />Jazz Other _______________________________ <br />Dancing: <br />(100’ required and shall not obstruct the normal flow of traffic.) <br />Checkdays of week: SU M TW TH F SA <br />Openair facility where noise may emanate <br />Stage will be provide <br />Lanai/Deck : If yes, <br />Do you intend to place speakers on lanai/deck?Yes No <br />Do you intend to allow entertainment on lanai/deckYes No <br />Do you intend to allow dancing on lanai/deck? Yes No <br />By:__________________________________ <br />Hawai'i County is an Equal Opportunity Provider and Employer <br />