HomeMy WebLinkAboutKatelyn Williamson App 610335 07 12 23 (t; ) ENVIRONMENTAL HEALTH
Catawba County Government Center
catawba county 25 Government Drive I P.Q. 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
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Tattoo Artist Information: 11 c,,�
First Name II.CLk.1L)Y\ Last Name iAi t 1�()WAJar\ MI
Moiling Address: (...4�_`` Q � �11(LS it:".)( AA
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City -1.1.7�t��� Stale L r_Zip 21l t () C1
Telephone Number: 101— / /`J l IC) .3 E-mail: LVttktcu s(Sl- /'`1 cl h 510 6 pou
Tattoo Establishment Information: / y�
Name of Establishment: _Two c/ Pre [.� 19eco)T , J-)i aL.,t[C�
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Street Address:. ("MD 1�• COI e-Oe. Rve..
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loins'Hours: IC)
Number of Tattoo Allots in Establishment -5 Anticipated Date to Begin Tattooing: RC) 'yL N T.
Tattoo Artist Signature:/�J7
Instructions
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute 1 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 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 feast 30 days before commencement of operation. The local health department may require payment of tees 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
COEST UNTY
NEWTON,NORTH CAROLINA 28658 RECEIPT
,.4. PHONE:828.465.8399
Wednesday,July 12,2023
1 4 2 sM www.catawbacountync.gov
PAYOR: Curtis&Co Spa
Curtis&Co Spa(Gutierrez,Dawn)
PAYMENTS
TRANSACTION NUMBER: TRC-6836 1 83 1-12-07-2023
PAYMENT DATE: 07/12/2023
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
07-23-425303 110-580200-663000 tattoo Artist Fee S225.00
TOTAL PAYMENTS: $225.00
FLI-06-2022-174247
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 601 S MAIN AVE,NEWTON NC 28658
Applicant KATELYN WILLIAMSON,2096 JENKINS PRINTING DR,NEWTON NC 28658
C:7047791063 WILLIAMSONKATELYN516@GMAIL.COM
Paid By CURTIS&CO SPA, 105 N COLLEGE AVE,NEWTON NC 28658
C:8282385739 DAWNMARIENAYLOR@GMAIL.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED••
receipt 07/12/2023 10:03 Pagel of 1