HomeMy WebLinkAboutDawn Curtis App 610219 07 12 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 Fox: (828) 465-8276
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Application for Tattooing Permit1
Date of Application (SJ 2-3 �� DO`ti-e`O)1
Tattoo Artist Information:
First Name , j (. Last Name r-'`\:r\er ! Ml r-R
Mailing Address: '
City Lp State k;C, Zip OcwoSE
Telephone Number: I]28 23B 5'r-7 39 E•trwil: al irbiln tct P rYf 1/4•11 snr)(11,L` • ( Pr)
Tattoo Establishment Information: _ J
Name of Establishment: —1 V- /C_� L3 �&CL.7L,,� v�
O Street Address: ` ' v
City 1ti1i51 State y1C-- Zip 2- 4,
Business Hours: (j JO.M - Sp tY1 & �"
Number of Tattoo Artists in Establishment •B Anticipated Date to Begin Tattooing:
Tattoo Artist Signature•
Instructions
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute J 30A•283 and ISA NCAC I 8A.3702. 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 Slate of North Carolina. The completed application must include the lull 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 401S(Revised 11/00)
Environmental Health Service Section(Review 1 I/03)
CATAWBA
WBA CO NT
E-4 t .tBLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
u , '1 PHONE:828.465.8399
Wednesday,July 12,2023
Ig 2 sM www.catawbacountync.gov
PAYOR: Curtis 8 Co Spa
Curtis&Co Spa(Gutierrez,Dawn)
PAYMENTS
TRANSACTION NUMBER: TRC-68361829-12-07-2023
PAYMENT DATE: 07/12/2023
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
07-23-425301 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FL1-1 1-20 1 7-092 1 89
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 105 N COLLEGE AVE,NEWTON NC 28658
Applicant CURTIS&CO SPA, 105 N COLLEGE AVE,NEWTON NC 28658
C:8282385739 DAWNMARIENAYLOR@GMAIL.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 07/12/2023 10.02 Page 1 of 1