HomeMy WebLinkAboutKayla Doughtrey 610314 app 12 09 22 GI ENVIRONMENTAL HEALTH
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
MAILING.LIVING.RITTER.
Email: EHAdmin@CatawbaCountyNC.gov
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Application for Tattooing Permit
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Date of Application
Tattoo Artist Information: `�
First Name 1 Ck_ Last Name 1/�11�U „�{ MI
Mailing Address: 3 5 3 9-- A V ECI- V 6
City F h C Y O( State 0 C Zip c Dv)
Telephone Number: g) L1 v- 31 d 1 E-mail: L- i.v-I e Ll -rkI Gl_ rLD l la., 1 . ( 0 oi
Tattoo Establishment Information:
Name of Establishment: kU`YY\Ci(A:( \(.t INC) ' A i C `0
It `�
Street Address: ��� ,� H� � YV Tor
City A. (UGU State NC--Zip (O 0
Business Hours: — 'J - S
Number of Tattoo Artists in Establishment 5 Anticipated Date to Begin Tattooing: ia� e� cc_. I
Tattoo Artist Signature: 1�(,4
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 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.
DEHR 4015(Revised 11/00)
Environmental Health Service Section(Review 11/03)
CATAWBA COUNTY
�'' I00A SOUTHWEST BLVD
+ NEWTON,NORTH CAROLINA 28658 RECEIPT
(.� Mr PHONE:828.465.8399
r Friday,December 9,2022
18 4 2 sM www.catawbacountync.gov
PAYOR:
Daughtrey,Kayla
PAYMENTS
TRANSACTION NUMBER: TRC-52898579-09-12-2022
PAYMENT DATE: 12/09/2022
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
12-22-415745 110-580200.663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FL I-10-2021-159928
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 2508 US 70 I IWY E,I IICKORY NC 28602
Applicant KAYLA DAUGHTREY,34 31ST AVE CI'NE,HICKORY NC 28601
C:8284053421
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 12/09/2022 12:31 Page 1 of 1