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 Name
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Name of Business Owner
Phone Number
Street Address
Mailing Address (invoice/correspondence)
Applicant is
If partnership, list name and address of each partner
If you have additional documents to send, please email them to eh@tooelehealth.org.
 
Is this for a Mobile Body Art Establishment?
Yes
No
If yes, please email eh@tooelehealth.org with dates and locations of each event. Pictures of the space used for the events must also be emailed.

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   Select:   Item Subtotal:  
$0.00
MOBILE BODY ART ESTABLISHMENT PERMIT(Annual):   $100.00   Select:   Item Subtotal:  
$0.00
Temporary Event Permit (per day/per event):   $15.00   Quantity:   Item Subtotal:  
$0.00
Late Fee If Applicable:   $   Item Subtotal:  
$0.00
Total:
$0.00
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Payment Information:
Method of Payment:
  Credit/Debit Card
  eCheck
 Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
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