HomeMy WebLinkAboutJeanie Vang Yours Beauty By Jeanie V Tattoo App 610332 05 25 22.tif 4
ENVIRONMENTAL HEALTH
Catawba County Government Center
catawba county 25 Government Drive I P.O. Box 389 f Newton, NC 28658
public health Phone: (828) 465-8270 I Fax: (828) 465-8276
MINING.&VINC.!EIIEI.
Email: EHAdmin@CatawbatountyNC.gov
Application for Tattooing Permit
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Date of Application OC(- " 4
Tattoo Artist Information: I�1 f Ul`I�'1 i
First Name f-e Last Name v -, MI
Mailing Address: (- 3 A ' �L� �MY J�
City State Zip ° !
Telephone Number: ( .P8) c 1 I - / d.-± E-mail: ,-P C(,t/1 c-e._ ` "t-"3 •
Tattoo Establishment Information:
Name of Establishment: 3 W Y 5 e;12 `^. 5 c) r i...(k(-P V .
Street Address: c I - 3 cJ
City 4t./lf-'6' State 1vC Zip c.bua 6 7
Business Hours: c( CkAo Sa-t)`(G I 0 0-4 P�1
Number of Tattoo Artists in Establishment 1 Anticipated Date to Begin Tattooing: U S162 C/C
Tattoo Artist Signature: /
Instructions
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute J 30A-283 and I5A 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 dote 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.
DEHR 4015(Revised 11/00)
Environmental Health Service Section(Review 11/03)