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 Temporary Body Art Establishment Permit
** Application and Permit Fee Schedule**
$15.00 per day, per booth, per location


Please put N/A for any fields that are not applicable
Event Name
Location
Event Coordinator
Phone Number
Booth Name
Booth Owner
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Booth Contact Person
Phone
Requested Permit Dates:
First Day
Last Day
Time of Operation:
From AM/PM
To AM/PM
What sanitation procedures will you be using at the event?
Will there be a hand sink at the temporary location?

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.
Booth Fee Per Day Per Booth:   $15.00   Quantity:   Item Subtotal:  
$0.00
*If you have multiple booths, you will need to complete an application for each booth.
Total:
$0.00
Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
I Agree
Applicant agrees that maintenance of a health permit is predicated on compliance with the Tooele County Health Department for Body Are Establishments. This permit is revocable for non-compliance.
Applicant's Signature
Date
 
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