HomeMy WebLinkAbout2018 Application 2 - The Residence wry Town of South Windsor - Health Department
1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address
1530 Sullivan Avenue, South Windsor, CT 06074 — Office Address
-+ y 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.
Name of Establishment: Bislence at South Windsor Farms
Address of Establishment: 200 Deming Street South Windsor CT
Phone&E-mail of Establishment: 860-432-2911
Name of Manager/Operator": Healthcare Cosmetology
Phone Number for 24-hour Emergency Contact:
Name of Legal Owner: South "'indsur Farms OPCO.LLC
Address for Legal Notices: 3 Edtrewaterrive Ste 101
Norwood MA 02062
License Fee:$50.00 per location
Type of Services Provided:❑✓ Barbering Q Hairdressing❑Nail Salon❑Casmetology❑Threading
❑Other
Water Supply: ®✓ Public E]Private(well) Sewage Supply: ❑✓ Public❑ Private(septic)
Is food or beverage provided for the public on site?❑YES ❑✓ NO HOURS OF OPERATION
If YES, please describe: SUNDAY to
MONDAY to
TUESDAY 9am t0 2pm
C Appl' nt Signature ate WEDNESDAY to
THURSDAY 9am to 2pm
Please Print Name FRIDAY to
*Nail Technicians are not currently required to obtain a personal SATURDAY ro
license in the State of Connecticut. CEI
Make checks payable to:Town of South Windsor
OCT 2 5 ?019
SOUTH WINDSOR
Office Use Only: HEALTH DEPT.
Date Paid: 15U Check Number: 11`7_ Cash: Other: _
Rev 7/5/18