HomeMy WebLinkAboutCesar Garcia 610383 app 08 23 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
N*[IN4. LIVING.IE'IEN.
Email: EHAdmin@CatawbaCountyNC.gov
Application for Tattooing Permit
�L� off ' - a03 l Date of Application /L"/ /2ID
Tattoo Artist Information: AA�
First Name CC2X.t( Last Name GCJ VCl CA MI 7T
Mailing Address: 1- co NA ti Be l l e / 5 C 1 V,
City 5-tuttes V l f C e State/V C. Zip l`IJ 2 S
Telephone Number: 1v6 SG�( G2 Email: t/'Gvtulibg-Oldc,lCl 13 1 CiG 06 Com
Tattoo Establishment Information:
Name of Establishment:Po S O 0 15 1—C4 t r C i f'v()I
Street Address: gj G ) cc) no Jet} () ud v i to f� J
City C U n cr U ild State A/C. Zip �� G
P a P Business Hours: `t e 5� { 0 U 1 ^ C� p v i- S c� _ r (0 P
Number of Tattoo Artists in Establish,f Anticipated Date to Begin Tattooing: Li I 2S/ —
ir % NO
Tattoo Artist Signature: '+1aimainfr
Instructions
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute J 30A-283 and I5A 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 loco!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.
DFNR 4015(Revised 11/00)
Environmental Health Service Section(Review 11/03)
i -4
$A olio. CATAWBA COUNTY
i�' 64 100A SOUTHWEST BLVD C/�c
��11 NEWTON,NORTH CAROLINA 28658 RECEIPT
`� PHONE:828.465.8399
V Ill Thursday,August 24,2023
I8 Z sM www.catawbacountync.gov
PAYOR:
cano cespedes,Y
PAYMENTS
TRANSACTION NUMBER: TRC-7 1 594 106-24-08-2023
PAYMENT DATE: 08/24/2023
PAYMENT TYPE: Credit Card
309879431
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
08-23-427331 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FLI-08-2023-203367
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 820 CONOVER BLVD W D,CONOVER NC 28613
Applicant CESAR GARCIA,260 MUELLERS CIR APT 260K,STATESVILLE NC 28625
C:7865998362 CESARARTUROGARCIA03@ICLOUD.COM
Paid By Y CANO CESPEDES,260 MUELLERS CIR,STATESVILLE NC 28625
C:7865998362
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 08/24/2023 16:40 Page 1 of I