HomeMy WebLinkAboutSarah Ghant Permit 610157 05 28 14.sc.pdf4. Anticipated Date to begin Tattooing:
1.) Enter an existing establishment number to UPDATE or renew permit
Permit Issue Date://
Water Supply:Waste Water:
Terrority #:
Time In:
Time Out:
Total Time:
1. Date of Application:
2. Tattoo Artist Information:
Name: First:Last:Middle:
Artist's Name as it will appear on the permit:
Mailing Address:
City:ST.Zip:
Phone:
3. Tattoo Establishment Information:
Name of Establishment:
Street Address:
Business Hours:
Number of Tattoo Artists in Establishment:
5. Tattoo Artist Signature:
Est. ID:
Old ID:
//
City:ST.Zip:
County:
EHS:
Signed:
Tattooing Permit
North Carolina Department of Health and Human Services
am
pm
am
pm
* Permit expires 12 months after this date
//
()-
:
:
OR
2.) Enter a NEW establishment number to CREATE a new permit.
052820142018610157
SARAH GHANT J
SARAH J GHANT
401VICRANDALLRD
LAWNDALENC28090
7042970908
INK THERAPY STUDIOS LLC
1960HWY70SESTE194
HICKORYNC28601
5
05282014
1-1 - Community 1-1 - Community
01 Catawba
1132
1200
28 minutes
1711 - Carpenter, Scott
05282014
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