HomeMy WebLinkAboutNancy Lee 610332 App 05 16 22 ENVIRONMENTAL HEALTH
Catawba County Government Center
c a t aw b a county 25 Government Drive I P.O. Box 389 I Newton, NC 28658
public health Phone: (828) 465.8270 I Fax: (828) 465-8276
MAKING.IIVING.BAIIIA.
Entail: ENAdrrtitti CotawbuCoutityfiC.yK
Application for Tattooing Permit
Date of Application
11) S12I6(,, 10 333
Tattoo Artist
First Name /1/c.d'k' '. last Name Lee, MI
Mailing
`/[Address: 2 i 5 ' cSIq/V On ,0a fry Re/
City /1 h State A/C/ Zip c2ifa50
Telephone Number: ZF1' /'/ 77 I1 E-mail: beyeat cie4n/
Tattoo Establishment Information 0 ���JJJ
Name of Establishment: //(//(S /e0D f S UQ /on
Street Address: / O Z Z 3rd '9t z° t!O - NL
City /71/40 /,J State /V( i Zip 28/
Q O/
Business Hours: / eU' - 6 torn
Number of Tattoo Artists in Establishment / *Anticipated Date to Begin Tattooing:
Tattoo Artist Signature: A/G g/f_e-—
Instructions
Purpose: To allow tattoo artists to apply far tattooing permits a s required in General Statute J 30A-283 and 15A NCAC I 8A.3202. A
separate application must be completed for each permit.
Preparation: Each tattoo artist must complete and sign a separate application for each location where he or she will engage in tattooing
within the State of North Carolina. The completed application must include the full name, mailing address and
signature of the tattoo artist, the name and street address of the tattoo establishment,and the anticipated date of
commencing operation.
Submission: The completed application must be submitted to the local health department in the county where the tattoo establishment is
located at least 30 days before commencement of operation. The local health department may require payment of fees or
additional information upon submission of the application.
Disposition: This form may be destroyed in accordance with Standard 7 of the Records Disposition Schedule. Published by the N.C.
Division of Archives and History.
DENR 4015(Revised 11/00)
Environmental Health Service Section(Review 11/03)