HomeMy WebLinkAboutBen Marchant Permit 610108 07 01 11SC.pdfNorth Carolina
Division of Environmental Health
Pennission is hereby graitted to
B e n T M a r c h a n t
Tattoo Artist
R a m b I i n R o s e T a t t o o
Place of Practice
FadlityID . .1 � 0 1 1 � 8 � � 1 � � � 6 1 0 1 0 8 El Existing Facility?
Old Facility H) (required if
Transitional)
WaterSupply: 1-1 -Community
Terrority #- 01
Address La -19 1-5--1 8H w y 1 1 a 1 7 1 IS
City L H -L i -1 c -L k I o I r Y
County Catawba
Waste Water System: 1-1 -Community
Permit is valid until: -Expiration DateLO I, / LO_L1_j / -
Vate i017 /1011 /1.421011111
Time In,- 0 5 6 11 am
91 Pm
Time Out: 0 3 3 3 Elam
- R1 Pm
Total Time: 37 minutes
sTLR,C, zip 2 8 6 101,�.
I t I W
Signed w"V Agent
D7NJn �ff tvironmenkl Health
EH, 1. D.# 1711 - Carpenter, Scott
Furpose GenEral Statute I 3CA-2,S3 states 'No person, shall engage in tattooing ivithout firs- obtaining a tattooing per-
mit Eom the DepaitrnenV . The pemilt is Emed to a lattoo artist who meets all regal rEmants ofRtdel, Govefn-
irg Tattoo irg 15 hT CAC I SA . 3 200. The Permit is not tran sfi--m. b le: to my offi Er person or place of practice
a,,.,id is valid for a, period of one year`_
Thisform is to be used as the per nit as specified above
Preparation.: Local envIlrom-nenla- I health specialist shall Issue a, pern-ilt every time a pmmt issuance is Indicated. Prepare
L471 c.TigijjLjj Yjjd IJJ2� C,t?ljy fQj-_
1, Original to tattoc artist
2, Cop fbr the I ocal health dep artment
Dlop,,olti=.: Fleas: refert,* Recordz R a tenion grad DlqDaojitvm Scli,edae for nuns pDv.,trict Heal'A DepLwh-nen to walch 10 publ I ohed by
&�e Notth. CarolinaDivisi on of 11storical Resources.
Addidumd faarxisiauy bu kndaud ftom- Division HuaLb
1632 Mul, Service Cmter
Raleigh, NC 27699-16341
(Comi er 52-0 1 -00)
DEK R 4016 (Radsed 7105)
-:::nvironmertal Health SErvices Section