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3 <br /> STATE OF NORTH CAROLINA <br /> ALCOHOLIC BEVERAGE CONTROL COMMISSION <br /> LOCAL GOVERNMENTAL. OPINION FORM <br /> To: <br /> Name Title <br /> County City Date <br /> Delivered By Title <br /> Received By Date <br /> PLEASE NOTE: If this notice is not returned to <br /> within fifteen days from date of receipt,it will be assumed <br /> that you have no objection to the issuance of the permit(s). <br /> Notice is given that application was made to the North Carolina Alcoholic Beverage Control Commission for a permit(s) <br /> to conduct business as indicated below: <br /> TYPE OF PERMIT(S)APPLIED FOR: <br /> ON PREMISES OFF PREMISES MDCED BEVERAGES(RESTAURANT) <br /> MALT BEVERAGE MIXED BEVERAGES(PRIVATE CLUB) <br /> UNFORT.WINE BROWNBAGGING (RESTAURANT) <br /> FORT.WINE BRowNBAGGING(PRIVATE CLUB) <br /> SPECIAL OCCASIONS <br /> OTHERS <br /> PLEASE INDICATE YOUR ANSWER WITH YES OR NO <br /> 1. Do you approve of the applicant? Applicant: <br /> 2. Do you approve of the location? Home <br /> Address• <br /> 3. Is the location in compliance T/A <br /> with local zoning ordinances? <br /> Business <br /> 4. Does the establishment comply Address: <br /> with all building and fire codes? <br /> City/State <br /> 5. If you have indicated disapproval by answering"no"to either Date of Birth <br /> question(1)(2)(3)or(4),please explain your reason(s)based <br /> on fact,record, law or reputation in the space provided. The NC Driver License# <br /> mere indication of"no"without an explanation is an insufficient Social Security# <br /> basis for rejection. Use extra sheets if additional space is <br /> required. <br /> ❑ Copy of Form delivered to local authority <br /> but not returned within fifteen days. Signature of Local Authority <br /> COPIES: Copy to local authority <br /> Copy to ALE Agent <br /> Copy for agent's record Title of Local Authority ;s„a <br />