HomeMy WebLinkAboutGuillermina Ochoa GGS Style & Beauty App 12 01 22 1111A. ENVIRONMENTAL HEALTH
e ` Catawba County Government Center
catawba county 25 Government Drive I P.O. Box 389 I Newton, NC 28658
public health Phone: (828)465.8270 I Fax: (828) 465.8276
MATING.LIVING.BITTEN.
Email: EHAdmin@CatawbaCountyNC.gov
Application for Tattooing Permit '
Date of Application I-aN I
Tattoo Artist Information:
First Name (CAS 0 e_4 IN1 4-)Da 1 Last Name 0 U'1 Q CA MI
Mailing Address: 9.q 10 (o T\1 S N N
`t E
- _ coy l i c_K.o Ycj State kiC Zip 60
Telephone Number: 9-8—7 R I -33 7(. E-mail: j(J7 tie-- GGh Oct 414`----)✓m a' l' C
Tattoo Establishment InfformaRion:
Name of Establishment: 6 6.S ST 1) I e — 13 eav
Street Address: 3 3 6 L- (� 'i`()i r R by ne. '137 vJ SE Q.6
City 'i ! State NC Zip a 6 o
Business Hours: I(' 3v " 5 40 3 U
Number of Tattoo Artists in Establishment 1 Anticipated Date to Begin Tattooing: \1 f 2 U 19-
Tattoo Artist Signature:
IInu xtructions
Purpose: To allow tattoo artists to apply for 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)
4'A-44
40111 ® CATAWBA COUNTY
100A SOUTHWEST BLVD
�+ Ilk, �" NEWTON,NORTH CAROLINA 28658 RECEIPT
T-2, (-‘1)-)
a PHONE:828.465.8399
�' Thursday,December 1,2022
1.842 SM www.catawbacountync.gov
PAYOR:
OCHOA MARTINEZ,GUILLERMINA
PAYMENTS
TRANSACTION NUMBER: TRC-52347859-01-12-2022
PAYMENT DATE: 12/01/2022
PAYMENT TYPE: Credit Card
298128054
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
12-22-415405 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FLI-12-2022-185414
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61-Tattoo Artists
SITE ADDRESS: 336 LENOIR RHYNE BLVD SE 6,HICKORY NC 28602
Applicant GUILLERMINA OCHOA MARTINEZ,2910 6TH ST NE,HICKORY NC 2860.1
C:8287813376 GUILLEOCHOA1144@GMAIL.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 12/01/2022 13:06 Page 1 of 1