HomeMy WebLinkAboutFLI-01-2023-187317.TIF ENVIRONMENTAL HEALTH RECEIVED
Cutuwlsu County Government Center
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catawba county 25 Government Drive I P.O. Box 384 I Newton, HC 2865tpAN 2023
''tl` Phone: (828) 465-8270 I Fox: (828) 465-8276
1010
Environmental Health
Application for Tattooing Permit
Dote of Applicotsn I ( GI r U 0 l )O)3 - / 7317
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First Name G`� Last Noe L ` i
MI
Mailing Address: 1 Da.(-ci(f2) 19r
Cite GU 10 tt'` Stota i1/4JV Zip J4‘9"1 r-t
Telephone Number: " V"(1`'161'°1 0415 E-mail: Ill VSla rt1 u Sf Vt_d t U 0 I Ili ct4 ! • \--
Nome of Establishment: _Lh I V- 5t DL ?ef t-1Q11e/n-1 I it-ikk/(if _ ht D
Sheet Address•. t b I r �-�{f t �iT s'{ s t- W p t f CIS
City C 9 State NCI Zip
Business Hours: lOsi Arti- O 1i 1 N R r' 1 --(11
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Vt(( o- C,At-01(n c s t7
Number of Tattoo Artists in Establishment I / Anticipate!Date to Begirt Imaging:
Tattoo Artist Signature:4t—‘129.&A
Purpose: To allow tattoo artists to apply far tenoning permits a s required In General Statute 130A•283 cod I5A NCAC I BA.3202. A
separate application most he completed ler each permit.
Preparation: Each tattoo artist must complete end sign a separate appficstiem for each location where he or she will engage in tattooing
within the State of North Cerelno. The completed appicetien must inchtde the fell name, mailing address and
signature of the toffee artist, the name and street address of the tattoo estabishment,and the anticipated date of
commencing operation.
Submission: The completed application must be submitted to tie load health deportment in tie county where the tattoo establishment is
located at least 30 days hefore rormoncememt of operation. The local ieahh department may require payment of fees or
additional information upon sobmissioe of the appficatios.
Disposition: This foray may hs destroyed i■acewaunta with Standard 7 of the Records Disposition Schedule.Published by the N.C.
Division of Archives and History.
DENR 4015(Revised 11/DO)
Environmental Health Service Section(Review 11/03)
1�$A CATAWBA COUNTY
3" 100A SOUTHWEST BLVD
NEWTON,NORTI I CAROLINA 28658 RECEIPT
PHONE:828.465.8399
l ^� Tuesday,January 10,2023
www.catawbacountync.gov
PAYOR: Inksia
Inksia(Lee,Sia)
PAYMENTS
TRANSACTION NUMBER: TRC-55135894-10-01-2023
PAYMENT DATE: 01/10/2023
PAYMENT TYPE: Credit Card
299611752
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
01-23-416622 II0-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FLI-01-2023-187317
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 1015 1ST ST SW,HICKORY NC 28602
Applicant 1NKSIA, 1058 S CENTER ST,HICKORY NC 28602
C:9809499095 SIAMICIIELL1 ,11:(;YA1100.COM
**NO PEOPLESOFTA000UNI ASSIGNED**
receipt 01/10/2023 08:45 Page 1 of 1