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San Juan County Health Department
735 S 200 W Suite 2, Blanding, UT 84511
Phone: (435) 587-3838
sanjuanpublichealth.org
Tanning Establishment
NOTE: Our Environmental Health Director will contact you about your application. If you have any questions please contact Dennis Shumway at (435) 587-3838 Ext: 3505
Establishment Information
Organization Name:
Address:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:
Email:
Contact Name
Contact Phone Number
Number of Tanning Beds
Applicant agrees that maintenance of a health permit is predicated on compliance with Utah State Rule R392-700, Indoor Tanning Bed Sanitation. This permit is revocable for noncompliance. Permit is valid for one year from the date issued.
Signature of Applicant
Title
Date
Tanning Establishment Permit Fee:
$109.00
Item Subtotal:
$109.00
Total:
$109.00
Payment Information:
Processing Fee Rates:
Cards:
2.5% ($1.50 min)
(1.5% additional service fee for foreign cards)
eCheck:
$0.75
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:
Payment method will be collected on external device
Change Payment Method
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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
Contact Name
is required
Contact Phone Number
is required
Number of Tanning Beds
is required
Signature of Applicant
is required
Title
is required
Date
is required
You must enter a payment method.
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