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Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435) 277-2444
www.tooelehealth.org
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
Individual
Partnership
If partnership, list name and address of each partner
If you have additional documents to send, please email them to eh@tooeleco.gov
Is this for a Mobile Body Art Establishment?
Yes
No
If yes, please email
EH@TooeleCo.Gov
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
'Please Select Method of Payment to Continue'
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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Organization Name: is required
Address: is required
City: is required
State/Province: is required
ZIP/Postal Code: is required
Phone: is required
Email: is required
Name of Business Owner
is required
Phone Number
is required
Street Address
is required
Mailing Address (invoice/correspondence)
is required
Applicant is
is required
If partnership, list name and address of each partner
is required
Applicant's Signature
is required
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