HomeMy WebLinkAboutKatelyn Taylor App 610281 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) 4b5.8270 I Fax: (828) 465.8216
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Email: EHAdmin@CatawboCountyNC.gov
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Application for Tattooing Permit IU itU>
81
Date of Application 15 2 I I 2 I J
Tattoo Artist Information: T I
First Name 16-it r\ Last Name ( ( MI P
Mailing Address: 2-I 3 T'Z1-V\ 1)(
City NaIAJ• r\ State 1 l J Zip
Telephone Number L1 t ) Sly- Je 3 s z Email: lit' 0-19 C K\ C#7L{ r I (A, 1 1 66 ' ceem
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Tattoo Establishment Information: hid
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Name of Establishment: _ 1 to L o (Lad Arc T LJ �Q S \-1A
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Street Address: �O`1 `! V M�1 1 1�1 p�
City N Q,LU 1-O Y1 State 't`� C Zip 2 x(3 CA
Business Hours: ? (v-
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Number of Tattoo Artists in Establishment 5 Anticipated Date to Begin Tattooing: k ..tea t,&ia
Tattoo Artist Signature
Instruction,
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute J 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 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 4015(Revised I I/00)
Environmental Health Service Section(Review 11/03)
t C OOA ATAWBA
COUNTY
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NEWTON,NORTH CAROLINA 28658 RECEIPT
PHONE:828.465.8399
�� Wednesday,July 12,2023
1842 SM www.catawbacountync.gov
PAYOR: Curtis&Co Spa
Curtis&Co Spa(Gutierrez,Dawn)
PAYMENTS
TRANSACTION NUMBER: TRC-68361832-12-07-2023
PAYMENT DATE: 07/12/2023
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
07-23-425304 1 t0-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: S225.00
FLI-05-2020-132947
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 105 N COLLEGE AVE,NEWTON NC 28658
Applicant KATELYN CHAPMAN TAYLOR,2953 TETON DR,NEWTON NC 28658
B:8285145332
Establishment CURTIS&CO SPA, 105 N COLLEGE ST,NEWTON NC 28658
Paid By CURTIS&CO SPA, 105 N COLLEGE AVE,NEWTON NC 28658
C:8282385739 DAWNMARIENAYLOR@GMAIL.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 07/122023 10:05 Page I of I