HomeMy WebLinkAboutDiego Hernandez App 610269 08 08 23 ENVIRON IENT4t WEAITH
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(nfvwha County Government Center
eataw to county 25 Government Drive ( P,O. Bax 384 ( Newton N( 28658
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..et.r ,,:�i et tr Phone: (828) 465•8210 i fox:($1$)AbS$?Ib
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Application for Tattooing 'cf miFt -07. q'1 f 7 ' s
Dote o1 App catioe _.._ ( I, °1 O MC )l�C
Tattoo Actitgt information:
First Name
!Olt 5o _,.._..._._ Iwo time
Meil no Address A.y !_Otis f\L
, i !; c1.or y IAf t.r —C.-b6C�
It l ,., ,,,: Z8 33`t�t�7 ` t ,,..,, --k. 0,\-\oo dgV4 . •Lh ac . c •C,S
Y
1
Nate of tstob:ishmcn. :IA l kQ
M I•Y k..s-�,).._c_..0
Street llddtets: _1 . :,h l,�n __Ay, �F
(Ay t k,�� State lip t 13 6,0 ` _
Business Hours:_ I. 3 r) r (pMl
i Number of Tattoo Artists in Establishment` f) Adiipded Data to Begin Tattooing:
Tattoo Artist Signature: /lL i
Instructions
Purpose: To allow tattoo artists to apply for tattooirg permits a s required in Gcn:tai Stchtc J 3 A al mod SA 14CAC I AA Titi:. A
separate application must be completed for each permit. „
:A ei n a sc orate application lot oath lotmion wbtxe tia et elsev a Opp to illiree�y
plCj>'1l:3tiOri= fait t th :rille u: i� 9 P
w�thir, rF.c State of Nor'i I ra. TI•c completed application must include the loll same, etaam esddran .ad
srgnatorc of the tattoo arts:, the none and street address of the tattoo estabhsixmri,math,e areldpated rcle it
fi commencing operation.
Sub ni
l ssi0tl: The completed application must be submitted to the local health departmeat in the county where the tattoo waltibbiseti
a
located at least 30 days before commencement of operation. The local health department may retake Pal
tials et Ion«
additiorai information upon submission of the application.
This Iorm may be destroyed in accordance with Standard 7 of the Records Disposition Sch�ele•pab�balby**I
Disposition:
Division of Archives and History.
DENR 4015(Revised 11/D0)seaaa Review i l/03)
Eeviroctostlol Head'Servi
CATAWRA COUNTY
loon sot IWES F RI.VI)
t,� NEWTON.ON.NOR"I I I('AR(H.INA 28658 RECEIPT
PI ION E:828..165.8399
v., 7Tuesday,August 8, 2023
18 41 SM \\ww.calawbacount•vne.gov
PAYOR: DHV Inkem Studio
DI IV Inkem Studio(I lern;tndez.Diego)
PAYMENTS
TRANSACTION NUMBER: iRC-70363691-08-08-2023
PAYMENT DATE: 08108r2023
PAYMENT TYPE Credit Card
309131553
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
08-23-426568 1 nr-58('uo-66'000 Tattoo Artist Fee S225.00
"DOTAL PAYMENTS: S225.00
FI.I-07-2019-11874
CASE TYPE: 1 ui d& Lodging Institutions WORK CLASS: 61 -'Fattoo Artists
SI I I:ADDRESS: 1 175 I II(il II.ANI)AVE NE A. I IICKORY NC 28601
Applicant 1)1IV INKEM S I I1DI(). 1106 PARK I,N,MORGANION N('28655
C':82833,1492I 'lAIIOOI)IIVru'YAIIOO.COM
**NO PEON.I(SOI I ACCOUNT ASSIGNED**
receipt OX:Og 2(12; In'fli Page I of I