HomeMy WebLinkAboutAshley Bost 610304 app 05 04 23 6/IN ENVIRONMENTAL HEALTH
Catawba County Government Center
Catawba county 25 Government Drive I P.O. Box 389 I Newton, NC 28658
public hers:: Phone: (828) 465.8270 I Fax: (828) 465.8276
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Email: EFlA dr;tirt(: CutnrvluCotrntyNC.gov
Application for Tattooing Permit i
Date of Application L1 z— +I2,.O. �,,. iD) 1)6G/ 10304
Tattoo Artist n rma ion: _
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First Name " �4 last Name ` .. ''''a a MI 1\4
iii Art Mailing Address: + —? I e#'` VI V ilt
City 14,l e''.1 State EV C. Zip 1.? 0 I
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Telephone Number: A .. 05 aT.;5.d i.mail: k h 6 o . ; 14104_tk. c a m
Tattoo Establishment Info:
Name of Establishment:E 160 S E,3 A t1 10 j1y NO c%.1t " L.LC
Street Address: 11 ( tf A a s f g
City 1..- G 1 L Slate P4 Czip 47I
Business Hours: 4r, —
Number of Tattoo Artists in Establishment ` Anticipated Date to Begin Tattooing: t'�'.rt: .4. t U,)
Tattoo Artist Signature: (_" + "1 a'`
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instructions
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute I 30A.283 and ISA NCAC I 8A.3202. A
separate application must be completed for each permit.
Preparation: Each tattoo artist must complete and sign a separate application far cads 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 I 1/03)
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NEWTON,NORTH CAROLINA 28658 RECEIPT
(..)710y.C PHONE:828.465.8399
Thursday,May 4, 2023
1842 sM www.catawbacountync.gov
PAYOR: Brows By Ashley Nicole
Brows By Ashley Nicole(Bost,Ashley)
PAYMENTS
TRANSACTION NUMBER; TRC-63295320-04-05-2023
PAYMENT DATE: 05/04/2023
PAYMENT TYPE: Credit Card
304817412
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
05-23-422085 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FLI-04-2021-149683
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 1110 1ST ST W A,CONOVER NC 28613
Applicant BROWS BY ASHLEY NICOLE,2351 4TH AVE NW,HICKORY NC 28601
B:8283036552
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 05/04/2023 10:28 Page 1 of 1