Tooele Health Department

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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 Temporary Body Art Facility 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

**Temporary Body Art Booths must be located inside of a building**- see R392-701-9 Specific Health and Sanitation Requirements for a Temporary Body Art Facility for more information on requirements.

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?

All applicants must provide: Current blood borne pathogen-training certificate, R392-701-11. Course available at: https://www.abovetraining.com/bloodborne-pathogens/utah/tooele-county-health-department Approved First Aid Course, R392-701-11 Proof of Hep. B vaccination series, Sec. 3.2 Aftercare Instructions, R392-701-11 (14) Client Consent and Disclosure Form r392-701-14
please email all required forms to eh@tooeleco.gov

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

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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