Change Of Structure Application - New Mexico Regulation And Licensing Department Page 5

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AGD Stamp
Revised 7/16
New Mexico Regulation and Licensing Department | Alcohol and Gaming Division
| Page 2
PO Box 25101 Santa Fe, NM 87504-5101 | Phone: (505) 476-4875 Fax: (505) 476-4595
PREMISES LOCATION, OWNERSHIP, AND DESCRIPTION
NMSA §60-6B-10
(check one)
1. The land and building which is proposed to be the licensed premises is:
Owned by Applicant, copy of deed/document attached
Leased by Applicant, copy of lease/document attached
Other (provide details): ____________________________________________________________________________
2. If the land and building are not owned by Applicant, indicate the following:
A. Owner(s): ________________________________________________________________________________
B. Date and Term of Lease:____________________________________________________________________
3. Premises location is Zoned
(
): _____________________________________________,
example C-1, see Zoning Statement
Zoning Statement attached, which must be obtained from the Local Government, listing the proposed
location by address, Type of Zone, state whether alcoholic beverages are allowed at proposed location, and if
applicable, whether packaged sales, patio service and/or manufacturing is allowable. If there is no zoning in the
proposed location, attach Statement from the local government, indicating there is no zoning
.
*
4. Distance
from nearest Church:
(Property line of church to closest point of licensed premises—shortest distance)
Name of Church: _________________________________________________________ Miles/feet: _________________
Address/location of Church: ___________________________________________________________________________
*
5. Distance
from nearest School:
(Property line of school to closest point of licensed premises—shortest distance)
Name of School __________________________________________________________ Miles/feet _________________
Address/location of School: ___________________________________________________________________________
6. Distance from military installation
*(
.)
Property line of military installation to closest point of licensed premises-shortest distance
circle one:
Name of Military Installation,
Kirtland Air Force Base (
), White Sands Missile Range (Las Cruces),
Albuquerque
Miles: ________________
Holloman Air Force Base (Alamogordo), Cannon Air Force Base (Clovis)
7. Attach Detailed Floor Plan, must include the Total Square Footage of premises; List nearest cross street;
Show which direction is North; Show each level (floor) where alcoholic beverages will be sold or consumed,
exterior walls, doors, and interior walls; Patio Area with type of barrier used; Highlight Bonded Areas. The
floor plan should be no larger than 8½ x 11 inches and must be labeled with designated areas highlighted,
which will reflect the proposed Licensed Premises.
8. Type of Operation
:
Hotel
Lounge
Package Grocery
Restaurant
Racetrack
Small Brewer
Craft Distiller
Winery
Wholesaler
Other (specify):__________________________________________________________________________________
*
NOTE: If the distance is beyond 300 feet, but less than 400 feet, a Registered Engineer or Licensed Surveyor
must complete a Survey Certificate showing the exact distance.

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