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Form #3-A Revised 7.08.24 1 I Page Dawson County Alcohol Licensing 25 Justice Way, Suite 2223 I [PHONE REDACTED] Certified Report of Survey For All Consumption on Premises and Retail Package Establishments The premises to be licensed must comply with the following minimum distance requirements to comply with the Official Code of Georgia 3-3-2; 3-3-21; Reg. 560-2-2-.32; and the Dawson County Consolidated Alcohol Ordinance. Applicant: Business Name: Address of Premises to be Licensed: 1. Church Building: "Church building" means the main structure used by any religious organization for purposes of worship. The premises to be licensed must be a minimum of 600 feet (200 yards) from the nearest church building, measured in a straight line from the front door of the licensed facility to the front door of the church building. County Ordinance References: Article 5 Section 501(A), Article 6 Section 600(B), Article 7 Section 700 Name and Address of Nearest Church: Distance Measured: 2. School Building or School Grounds: "School building or school grounds" shall apply only to state, county, city, or church school buildings and to such buildings at such other schools in which are taught subjects commonly taught in the common schools and colleges of this state and which are public schools or private schools. The premises to be licensed must be a minimum of 600 feet (200 yards) from any school, educational building or college, measured in a straight line from the front door of the licensed facility to the front door of the school, educational building or college. County Ordinance References: Article 5 Section 501(A), Article 6 Section 600(B), Article 7 Section 700(B) Name and Address of Nearest School: Distance Measured: 3. Daycare: "Daycare" means any place operated by a person, society, agency, corporation, institution, or group wherein are received for pay for group care for less than 24 hours per day, without transfer of legal custody, children under 18 years of age, and is not accredited as a ---PAGE BREAK--- Certified Report of Survey Form #3-A Revised 7.08.24 2 I Page public or private school (except that centers offering state funded pre-K programs are still considered daycares). The premises to be licensed must be a minimum of 600 feet (200 yards) from the nearest daycare, measured in a straight line from the front door of the licensed facility to the front door of the daycare. County Ordinance References: Article 5 Section 501(A), Article 6 Section 600(B), Article 7 Section 700 Name and Address of Nearest Daycare: Distance Measured: 4. Alcohol Treatment Facility: "Alcohol treatment facility" means any alcohol treatment center owned and operated by the State or the County government. The premises to be licensed must be a minimum of 600 feet (200 yards) from the nearest alcohol treatment facility, measured in a straight line from the front door of the licensed facility to the front door of the alcohol treatment facility. County Ordinance References: Article 5 Section 501(A), Article 6 Section 600(B), Article 7 Section 700 Note: The only State or County operated alcohol treatment facility is Dawson County Treatment Court, 189 Highway 53 West, Suite 106, Dawsonville, GA 30534. Name and Address of Nearest Alcohol Treatment Facility: Distance Measured: 5. Another Package Store: ***Applies to Package Liquor Stores Only*** No license shall be issued under this ordinance for use at a location which is within one mile (1,760 yards) of any other business licensed to sell packaged liquor (distilled spirits) at retail. This distance shall be measured in a straight line from the front door of the licensed facility to the front door of the other package store. This restriction shall not apply to any location for which a new license is applied if the retail package sale of distilled spirits was lawful at such location during the 12 months immediately preceding such application. County Ordinance Reference Article 5 Section 501(B) Name and Address of Nearest Package Liquor Store: Distance Measured: 6. Housing Authority Property: ***Applies to Alcohol by the Drink Establishments*** There is NO housing authority property in Dawson County. "Housing authority property" means any property containing 300 housing units or fewer owned or operated by a housing authority created under the State Housing Authorities Law. The premises to be licensed must be a minimum of 600 feet (200 yards) from the nearest housing authority property, measured in a straight line from the front door of the licensed facility to the front door of the housing authority property. County Ordinance Reference Article 7 Section 700(B) Name and Address of Nearest Housing Authority Property: in Distance Measured: ---PAGE BREAK--- Certified Report of Survey Form #3-A Revised 7.08.24 3 I Page Note: A scale drawing (by a Georgia Registered Land Surveyor/Engineer) of the location of the premises to be licensed, showing the closest prohibited structures and identifying the minimum distance, must be attached hereto. The License Applicant Completes the Following Certification: The undersigned certifies that subject location is in compliance or non-compliance with the distance requirements set forth above. I have found: (check one) above listed structures are inside the minimum distance restrictions stated above or The premises to be licensed meets the minimum distance requirements for licensing stated above. Applicant’s Printed Name Applicant’s Signature Date of Signature Notary’s Signature Date of Signature