HomeMy WebLinkAbout2018 Application - Paulies ,owN sf,� Town of South Windsor — Health Department
Pl ' 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address
1530 Sullivan Avenue, South Windsor, CT 06074 — Office Address
1 Phone Number: (860) 337-6173 Fax: (860) 644-1930
COSMETOLOGY LICENSE APPLICATION
Please review and provide the requested information for your establishment. Incomplete or
unpaid applications will delay the issuance of your license. Any license issued pursuant to this
application will be subject to applicable State and South Windsor Regulations. Licenses are not
transferrable. ^� r
Name of Establishment: _ (auk- li(;S f'11)Fe SSIDh 4l i_-�)a(tx r5h�(�
Address of Establishment: H L1; ( 6,Yh rl RCI• Spkt 1 �4i'nclSOY G-
Phone & E-mail of Establishment: N�0) 43)=- cl I-1 3
Name of Manager/Operator*: _PG-Us..1 L a ChancQi
Phone Number for 24-hour Emergency Contact: b0 5 4
Name of Legal Owner: �cm i l-�i Ch LLI1C
Address for Legal Notices: q LLr-A L1 0 h d (� -
SU�t�� 1Jinc� �oi� , CT ���474
License Fee: $50.00 per location
Type of Services Provided: Barbering❑ Hairdressing❑ Nail Salon El cosmetology❑Threading
6 Other
Water Supply: Public❑ Private (well) Sewage Supply: � Public❑ Private (septic)
Is food or beverage provided for the public on site? ❑ YES [ NO HOURS OF OPERATION
Cc.oC—ram
If YES, plea ribe: SUNDAY �
MONDAY
kv TUESDAY to
Appli' nt Signatu Da a WEDNESDAY to
THURSDAY to
--Pau ! LaLhGh(� —
Please Print Name FRIDAY to
*Nail Technicians are not currently required to obtain a personal SATURDAY to I
license in the State of Connecticut.
Make checks payable to: Town of South Windsor
Office Use Only:
Date Paid: Check Number Cash: Other:
Rev 7/5/18