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2. 
3. City of Yachats
   501 Highway 101 N
   PO Box 345
   Yachats, OR 97498
4. Phone: 541-547-3565
   Fax: 541-547-3063
6. Application is made for:*

   1. Little Log Church
   2. Yachats Commons
   3. Other City Property
7. If "Other City Property", please specify:
9. Applicant Name*
11. Phone Number*
13. Person Responsible at the Event*
15. Mailing Address*
17. Type of Event
18. The event will be:*

    1. Open to the Public
    2. Open to the Public by Ticket
    3. Private Party
20. Type of Alcohol Being Served*

    Check all that apply

    1. Beer
    2. Wine
    3. Spirits
21. Will alcohol be sold?*

    1. Yes
    2. No
23. Date(s) and Hours of Event(s)
    Date(s) and Hours of Event(s) Start Date

    Date(s) and Hours of Event(s) Start Time

    —

    Date(s) and Hours of Event(s) End Date

    Date(s) and Hours of Event(s) End Time
25. Location of Event*

    1. Inside Building
    2. Outside
26. Expected Number of Attendees*
27. Will minors attend the event?*

    1. Yes
    2. No
29. Please describe the supervision and security measures to be taken to ensure disclaimers at bottom are met:*
33. Is an Oregon Liquor Control Commission (OLCC) permit required? OLCC permits are required for all alcohol sales.*

    1. Yes
    2. No
34. Has an Oregon Liquor Control Commission (OLCC) permit been secured?

    1. Yes
    2. No
38. Disclaimers
    • The City office may require a written statement outlining how applicant is complying with the OLCC regulations and copies of OLCC service permits for anyone who will be serving.
    • The City, OLCC or Sheriff's Office may close the sale of alcohol at any time during event at their discretion.
    • The sale and consumption of alcohol will be contained within well-defined boundaries. Hours of sale and security requirements will be determined by the OLCC with input from the Lincoln County Sheriff's Office.
    • The sale or consumption of alcohol at events in the Commons, Log Church Museum, or city parks will be by permit only.
    • The sponsoring group will be responsible to maintain adequate controls to ensure that:
      • Alcohol will be consumed within designated areas
      • No cans or bottles of alcohol will be brought into event area from outside event area
      • No person under the age of 21 years is served
      • No person will be served who appears to be intoxicated
      • Servers are at least 21 years of age
    • Security must be provided by the sponsoring group at its sole cost and expense at each point of distribution to enforce regulations and closure. Alcohol will be limited to beer and wine only, two cups per customer per visit, and dispensed in cups only - no cans or bottles.
42. Agreement
    I have read and agree to comply with the regulations listed on the reverse side of this form. I further agree that I shall indemnify and defend City, its boards, commissions, officers, agents and employees against any and all liabilities for injury or death of any person or any damage to any property caused by any acts or omissions of (Applicant), applicant’s officers, agents or employees, arising out of the exercise of any right or privilege extended to the applicant under this Application for use of alcohol on City property.
44. Electronic Signature*
45. Date*
    Date
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field