HomeMy WebLinkAboutBryce Staton 610366 App 03 22 23 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
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Email: EHAdmin@CatawbaCountyNC.gov
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Application for Tattooing Permit
Date of Application r✓ -2 2— Z 'D 2 0 1 is le 0 7 i_r_
Tattoo Artist Information: le J(AID
First Name hrCe Last Name 5+c t+ MI
Mailing Address: 2 3 r 4 5+ 1 r NE
City C k prj State N C Zip Z�()O I
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Telephone Number: E-mail: J)
Tattoo Establishment Information:�
Name of Establishment: S ' �" OD e-rPar.rJrn / thQ, S'1'U 4I0
Street Address: I E. B S.±
City N e vV ton State IV C Zip t 5-%
Business Hours: 1-U e - 3 Am
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Number of Tattoo Artists in Establishment Anticipated Date to Begin Tattooing: O 0 I — Z 3
Tattoo Artist Signature:
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.
DENR 4015(Revised 11/00)
Environmental Health Service Section(Review 11/03)
� A Cp CATAWBA COUNTY
��" „{, 100A SOUTHWEST BLVD
'l NEWTON,NORTH CAROLINA 28658 RECEIPT
c.. ...730 �, PHONE:828.465.8399 Wednesday,March 22, 2023
4 sM www.catawbacountync.gov
PAYOR:
Staton,Bryce
PAYMENTS
TRANSACTION NUMBER: TRC-60199075-22-03-2023
PAYMENT DATE: 03/22/2023
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
03-23-420122 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FLI-03-2023-191983
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 106 E B ST,NEWTON NC 28658
Applicant BRYCE STATON,2548 23RD ST DR NE,HICKORY NC 28601
C:8283285549 BRICMADDOG@GMAIL.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
03/22/2023 12:59 Page 1 of 1