HomeMy WebLinkAboutChloelynn Naylor App 610286 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 Fax: (828) 465-8276
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Email: EHAdmin@CatowboCountyNC.gov
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Application for Tattooing Permit
Date of Application 2`CA I
Tattoo Artist Information: r, n
First Name C \G1 y if �/� `La�stt Name eAV��%\r MI S
Mailing Address: L�7O • 1 r 1 A\ O A.1,
City �e1 I,)"[L_] II State kAG zip ate, 9
Telephone Number: � ''3P) "l E-mail: C\OQ.• .t•icq\or 3 O C q \Ot 1 1 .CC3
Tattoo Establishment Information: *�-�J
Name of Establishment: 11 1 ^ F�c0 aneC' be.a, y S�t.1d kG
`Street Address: 1 �) \v f €1 GJP (AA�1[.,
City Q1 -4z:.‘tfl Staff QC Zip Q(C CD-8
Business Hairs: Qrn `5-pry)
Number of Tattoo Artists In Establishment 5 Antklpated Date to Begin Tattooing: I i I a.,�
Tattoo Artist Signature: � '�Y • '''[a —
Instructions
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute 130A•283 and l5A 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 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 1 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)
CATAWBA COUNTY
100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
PHONE:828.465.8399
Wednesday,July 12,2023
8 4 2 sM www.catawbacountync.gov
PAYOR: Curtis&Co Spa
Curtis&Co Spa(Gutierrez,Dawn)
PAYMENTS
TRANSACTION NUMBER: TRC-68361833-12-07-2023
PAYMENT DATE: 07/12/2023
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
07-23-425305 110-580200.663000 Tattoo Artist Fee S225.00
TOTAL PAYMENTS: $225.00
FLI-08-2020-136557
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 105 NORTH COLLEGE AVE,NEWTON NC 28658
Applicant CHLOELYNN NAYLOR,601 S MAIN AVE,NEWTON NC 28658
CHLO EN AY LOR320@G M A l L.COM
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**
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