Tattoo Facility Application
Source: www.scdhec.net
Topic: Tattoo
Sort Desciption: Check this block if you have additional tattoo artists other than the four identified above that are working at this facility and ...
Content Inside: DHEC Form 234 (12/06) 1 [Records Retention Schedule #SBH-F&S 17] Application For License TATTOO FACILITY Division of Health Licensing In accordance with ยง44-34-10 of the South Carolina Code and Regulation 61-111, owners and prospective owners must file an application under oath prior to engaging in the business of tattooing, and annually thereafter. Licenses are effective for a 12-month period following the date of issue. 1. A. ________________________________________________________________________________________________ (Name of facility to be licensed) B. ________________________________________________________________________________________________ (Street Address or Location) C. ________________________________________________________________________________________________ (City) (County) (Zip Code) (Telephone #) D. ________________________________________________________________________________________________ (Mailing Address, if different) (City) (State) (Zip Code) E. ________________________________________________________________________________________________ (e-mail address) 2. Reason for application (check one or more): A. New business (Initial License). See item # 11. Number of Tattoo Stations to be licensed: _______________ B. Renewal of License #______________ which expires _____________. Current # of Tattoo Stations: _______ C. Change of: (1) ownership from __________________________________________________________________ to___________________________________________________________________________________ (2) name of business from_____________________________________________________________ to___________________________________________________________________________________ (3) address of business from____________________________________________________________ to___________________________________________________________________________________ (4) Number of Tattoo Stations from _________to_________ 3. Administrative O ...
application for license tattoo facility dhec