Pool Hall License Application

License Application for - Pool Halls

MUNICIPAL CODE SECTION – 4-36
South Bend Municipal Code: Section 4-36

DEFINITION:

Pool Hall or Billiard Hall: Any establishment which keeps, maintains, or operates for hire on the premises four (4) or more pool or billiard tables.

GENERAL INSTRUCTIONS:
1. Assemble all required information and materials before filing application.
2. Thoroughly review all applicable Municipal Code Sections listed above.
3. Licenses expire January 31.
4. Add 10% to license fee for renewal after January 31.
5. Include $5.00 license application fee payable to City of South Bend. You may pay this in person at City Hall or over the phone to the Business Licensing Manager at 574-235-5912.
6. License fee payable to City of South Bend due at issuance - $100.00.
REQUIRED INFORMATION AND MATERIALS:
1. Facility seating capacity and number of employees.
APPLICATION PROCESS:
1. Submit Application with $5.00 Processing Fee.
2. Police background check of applicant.
3. Inspection by Fire and Building Departments, as required.
4. License issued upon approval and payment of the license fee.
5. See Municipal Code Section 4-16 for denial or revocation.

Application Type
Is this application pertaining to a new restaurant or are you renewing your existing permit?*

New PermitRenew Permit
Business Data
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does Mailing address differ from Property Address?*

Yes, different addressNo, Same address
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Business Email Address*
example@example.com
Type of Zoning at Business Location*
Use the Zoning Map to determine your business's Zoning Type.
Number of Employees*
Maximum Seating Capacity*
Owner's Personal Data
Owner's Legal Name*

First NameMiddle NameLast Name
Owner's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner's Home Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Email*
example@example.com
Last four digits of Owner's Social Security Number*
Upload a copy of the Owner's Driver's License or other Government-Issued ID*

Cancelof
Owner's Date of Birth

MonthDayYear
Owner's Race*
Owner's Gender*
Is there an operator other than the owner?*

YesNo
Operator's Legal Name*

First NameLast Name
Operator's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Operator's Home Number*
Please enter a valid phone number.Format: (000) 000-0000.
Operator's Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Operator's Email*
example@example.com
Last four digits of Operator's Social Security Number*
Copy of Operator's Driver's License or other Government-Issued ID*

Cancelof
Operator's Race*
Operator's Gender*
Operator's Date of Birth*

MonthDayYear
Signature
I, hereby, certify and affirm that all the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Pool Halls license found in the City of South Bend Municipal Code, Section 4-36.
Electronic Signature*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

License Application for - Pool Halls

DEFINITION:

GENERAL INSTRUCTIONS:

REQUIRED INFORMATION AND MATERIALS:

APPLICATION PROCESS:

Application Type

Business Data

Owner's Personal Data

Signature