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 Massage 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
Mailing Address (invoice/correspondence)
Applicant's Phone Number
Applicant's Address
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@tooelehealth.org.
Applicant agrees that maintenance of a health permit is predicated on compliance with the Tooele County Health Department Regulations for Massage Establishments. This permit is revocable for non-compliance. Permit is valid for one year from date issued.
Signature of Applicant
Date
Massage Establishment Permit:   $50.00   Item Subtotal:  
$50.00
Total:
$50.00

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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:
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