Tooele Health Department
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444

Application for Body Art Establishment Permit
Please put N/A for any fields that are not applicable
Establishment Information
Organization Name:
City: State/Province: ZIP/Postal Code:

Name of Property Owner
Phone Number
Street Address
Mailing Address
Applicant is
If partnership, list name and address of each partner

Applicant agrees that maintenance of a health permit is predicated on compliance with the
Tooele County Health Regulations for Body Art Facilities.
This permit is revocable for non-compliance.
Permit is valid for one year from date of issue.

Applicant's Signature

BODY ART ESTABLISHMENT PERMIT (Annual):   $100.00   Item Subtotal:  
Late Fee If Applicable:   $   Item Subtotal:  
Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
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