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Home My WebLink AboutThao Spencer 610267 App 01 26 23 (i) 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 UMW.WWM. Email: EHAdmin@CatawbaCountyNC.gov P14 67-)or.//sits`? Application for Tattooing Permit Date of Application 12/12/2022 / ,�O/ 5& ' 'J 7 Tattoo Artist Information: First Name Thao Lost Name Spencer MI Mailing Address:2488 Birdie Ln NE aty Conover state NC zip 28613 Telephone Number: 8284460055 E-mail:thao@leflaire.com Tattoo Establishment Information: Name of Establishment: Le Flaire Beautique Street Address: 217-D 1st Ave S tiny Conover State NC zip 28613 Business Hours: By appointment only Number of Tattoo Artists In Establishment 1 Anticipated Date to Begin Tattooing: Tattoo Artist Signature: 'L.S` J Instructions Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute J 30A-283 and 15A NCAC 18A.3202. A separate application must be completed for each permit. Preparation: Fads 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) $A CATAWBA COUNTY �' IOOA SOUTHWEST BLVD `41 j NEWTON,NORTH CAROLINA 28658 RECEIPT +• PHONE:828.465.8399 U �" Thursday,January 26,2023 1$ Z 5M www.catawbacountync.gov PAYOR: Leflaire Beautique Leflaire Beautique(Spencer,Thao) PAYMENTS TRANSACTION NUMBER: TRC-56284903-26-0 1-2023 PAYMENT DATE: 01/26/2023 PAYMENT TYPE: Credit Card 300322887 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 01-23-417302 110-580200-66300o Tattoo Artist Fee $225.00 TOTAL PAYMENTS: $225.00 FL1-07-2019-1 1 8489 CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists SITE ADDRESS: 217 1ST AVE S D,CONOVER NC 28613 Applicant LEFLAIRE BEAUTIQUE,2488 BIRDIE LN NE,CONOVER NC 28613 H:8284460055 **NO PEOPLESOFT ACCOUNT ASSIGNED** Paid By LEFLAIRE BEAUTIQUE,2488 BIRDIE LN NE,CONOVER NC 28613 B:8284460055 'FIIAO@LEFLAIRE.COM receipt 01/26/2023 10:02 Page 1 of 1 catawba county public health AUTHORIZATION OF REFUND Date: 4/4/2023 Case #: FLI-07-2019-118489 Applicant: Thao Spencer Refund Amount: S225.00 Refund Reason: application withdrawn Authorizing Signature: I:— � Received By Staff: LL` (• Date: 403 catawbacountync.gov Environmental Health Cotowbo County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 I 828.465 8270 MAKING. LIVING. BETTER. Catawba County, North Carolina - Disbursement Voucher Vendor No. Date: 4/4/2023 Make Payment To: Co6 Voucher No(s) Thao Spencer Q' } 2488 Birdie Ln NE :p Conover, NC 28613 ATTACHMENT Prepared by: Julia English Description Amount Application for Tattoo permit withdrawn $225.00 Sub-Total Food Tax Sales Tax Total $ 225.00 For Accounting Use Fund Cost Center I Object Project Amount Only 110 580200 663000 Total The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE-APPROPRIATE OFFICIAL) co CATAWBA COUNTY (-4. -iy-,A � 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT U 4i. �.5+. PHONE:828.465.8399 Tuesday,April 4,2023 1\8 4 2 5M www.catawbacountync.gov PAYOR: Leflaire Beautique Leflaire Beautique(Spencer,Thao) PAYMENTS TRANSACTION NUMBER: TRC-61143147-04-04-2023 PAYMENT DATE: 04/04/2023 PAYMENT TYPE: DV INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 01-23-417302 110-580200-663000 Tattoo Artist Fee ($225.00) TOTAL PAYMENTS: ($225.00) FL I-07-20 1 9-1 1 8489 CASE TYPE: Food&Lodging Institutions WORK CLASS: 61-Tattoo Artists SITE ADDRESS: 217 1ST AVE S D,CONOVER NC 28613 Applicant LEFLAIRE BEAUTIQUE,2488 BIRDIE LN NE,CONOVER NC 28613 H:8284460055 **NO PEOPLESOFT ACCOUNT ASSIGNED** Paid By LEFLAIRE BEAUTIQUE,2488 BIRDIE LN NE,CONOVER NC 28613 B:8284460055 THAO@LEFLAIRE.COM receipt 04/04/2023 14:28 Page 1 of 1