HomeMy WebLinkAboutTorry Williamson Tattoo App 610290 11 30 22 . ,, ENVIRONMENTAL, EALTH
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'r Catawba County Government Center
catawba county 25 Government Drive I P.O. Box 389 I Newton, NC 28658
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Application for Tattooing Permit FL(-Iko)o
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Date of Application l `` 2,9 "2 2 I ee 1-17t I,S(l red l to
Tattoo Artist isr�Lor zi ati sv,
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First Nome—ID V U1 Last Name `�U \\ \ l Gt h1 S U MI
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City r{' 1 .bVc1V-) State N Clip 2 b (-C.3 J
Telephone Number: C6 C C — -(.42 —2Z 1 E-mail: 't()V V o�•Z' 1 \ k j Oak SO O1 e 9 040 i 1 , c a ..----i
Tattoo Establia aims nfoYxrgatian:
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Name of Establishment: TT_r \.i l- ;e. Lc_
Street Address: 1.2C) C_ZY\C U EL-c.- )1U'A 1�1L3t—
City C 4''`nc\;e \ State �C__- Zip / li U
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Business Hours: \I\(>Y1- �C; `7 - C- 12 -(S--
Number of Tattoo Artists in Establishment , 3 Anticipated Date to Begin Tattooing: J )J4-
17
Tattoo Artist Signature: t � V---C.'(.) (2,.[ii'(,'(1, -
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Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute J 30A-283 and l5A NCAC I 8A.3202. A
separate application must be completed for each permit.
rreparaeion: Each tattoo artist must complete and sign a separate application tor 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)