HomeMy WebLinkAboutJamie Cain App 610097 01 30 23Va
ENVIRONMENTAL HEALTH
Catawba County Government Center
atawba county 25 Government Drive I P.O. Box 389 I Newton, NC 28658
public health Phone: (828) 465-8270 I Fax: (828) 465.8276
MNIING.LIVING.BETTER.
Email: EHAdmin@CatawbaCountyNC.gov
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Application for Tattooing Permit
Date of Application 1 i 3 CJ/2_
Tattoo Artist Information: fFirst Name j itwej last Name e,a
(� MI V
Mailing Address: 20 S 3 l S7- Ali 1J
City C. State Alt Zip 291e C i
Telephone Number: ( L)y L'2-'7, v L E-mail: )0411 c 49, . et:(,(1.4_6)1(t 0 LA...A — ( ' -
Tattoo Establishment Information:
Name of Establishment: PirA:(1%S tf�( Y""t(1 S L-A
Street Address: g PI I q- 4—. )/L• ,,S1 J
ti�L Z 6 Z
City frLlC U� I State y Zip
Business Hours: j I — cS6'— A` /)
Number of Tattoo Artists in Estab ishment ? Anticipated Date to Begin Tattooing: / S/9 I�
Tattoo Artist Signatur •
Instructions
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute 130A•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.
DENR 4015(Revised 11/00)
Environmental Health Service Section(Review 11/03)
.1 ' • CATAWBA COUNTY
-7' t lik A100A SOUTHWEST BLVD
NEWTON,NORTH C.AROLLNA 28658 RECEIPT
Q 41.9 - PHONE: 828.465.8399
*> Monday,January 30, 2023
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PAYOR:
Cain,JAMIE
PAYMENTS
TRANSACTION NUMBER: TRC-56581129-30-01-2023
PAYMENT DATE: 01/30/2023
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
01-23-417549 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FLI-5-10-7432
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 874 14TH ST DR SW,HICKORY NC 28602
Applicant JAMIE CAIN,2035 31ST AVE DR NE,HICKORY NC 28601
C:3364027502F:NONE JAMIE.CAtN(:ICLOUD.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
OlVilef LAXON PROPERTIES,LLC,, NC