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 Plan Review

Please put N/A for any fields that are not applicable
Business Owner's Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Establishment Name
Phone Number
Street Address
Mailing Address
Types of Services Offered (mark all that apply)
Tattooing
Permanent Makeup
Body Piercing
Branding
Is this for a Mobile Body Art Establishment?
Yes
No
                                                     If yes, do you currently have a
TCHD permitted establishment?
Yes
No
If yes, what is the name of the establishment?
 
PLAN REVIEW
                                                       
                                                          
If you have additional documents to send, please email them to eh@tooelehealth.org.

Requirements for Premises, see Section 11 for more information:
  • Separate, readily accessible hand-sink, Sec. 11.7
  • Minimum 1 hand sink per 3 operators and lavatory, Sec. 11.7
  • Plan review fee, Sec. 11.1
  • Solid Partitions or walls from rooms that may cause potential contamination, Sec. 11.2
  • 45 square feet floor space or each operator, Sec. 11.4
  • Storage area for instruments and supplies, Sec 11.9

Required Forms:
  • Disclosure statement and notice for filing a complaint (provided by TCHD), Sec. 5.1
  • Medical release form, Sec. 6.1
  • Inventory and Body Art Procedure, Sec. 3.1
  • Minor, parental consent form, Sec. 7.1, 3.10, 15.1
  • Establishment and Employee information, Sec. 3.1
  • Scale drawing of floor plan, Sec. 11.1

All of the above statements are true. I understand that any false information on this application may be cause for denial or revocation of my Body Art Health Permit. Permits may be revoked or suspended for violation of
Tooele County Health Department Regulation #10.
Permits are non-transferable.
Non-permitted establishment, need to pay $100 for the Mobile Body Art Establishment plan review.
Current permitted establishment, do not need an additional fee, but we will still need them to fill out the application.
BODY ART ESTABLISHMENT PLAN REVIEW:   $175.00   Select:   Item Subtotal:  
$0.00
Total:
$0.00

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