Dance Hall License Application

First Name

Last Name

Street Address
Please provide only the house number and street name.

City

State

Zip Code

Phone Number

Email Address

Relation to Dance Hall operator
- select - Owner Partner Officer of Corporation

Title

Area of dance floor, in square feet

Is there a hotel or rooming house in the same building?
- select - Yes No

Number of exits leading out of Dance Hall

Number of women's restrooms

Number of men's restrooms

Number of unisex restrooms

Name of Dance Hall or dance area

Address of Dance Hall

Name of operator of dance hall or dance area

Have you ever been arrested?
Yes
No

If yes, state the nature of the charges.

Do you have a St. Louis liquor or beer license?
Yes
No

Do you have a St. Louis restaurant license?
Yes
No

Hours for inspection
Provide days of week and times of day available for inspection.

Inspection(s) needs to be by appointment

The undersigned hereby makes application for a license to operate a public dance hall or ballroom at the above address.

The undersign hereby agrees to comply with all City of St. Louis Ordinances.
The undersign hereby agrees to comply with all City of St. Louis Ordinances governing the operation and conduct of dance halls.

The undersigned further certifies that the answers to the questions below is true.

Type full name to indicate acceptance and agreement with above information and terms.