HomeMy WebLinkAbout2018 Application - Studio Nails 10,4N sf,( Town of South Windsor — Health Department
r'1 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address
- 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address
r: 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: //e t l J
Address of Establishment:
Phone & E-mail of Establishment: 01? y`' - �yJ /G� /iiz7C
Name of Manager/Operator*: 4/Li/// Rt
Phone Number for 24-hour Emergency Contact:
Name of Legal Owner: 12���
Address for Legal Notices: �� �C(/L C[' i S,' A G'f�
��' lii7C ht J` C/ i
License Fee: $50.00 per location
Type of Services Provided: ❑ Barbering❑ Hairdressing Nail Salon ❑ Cosmetology❑Threading
❑ Other
Water Supply: ❑ Public❑ Private (well) Sewage Supply: Public ❑ Private (septic)
Is food or beverage provided for the public on site? ❑ YES NO HOURS OF OPERATION
SUN DAY to
If YES, please describe
MONDAY ( to
TUESDAY to
Applicant Signature Date WEDNESDAY7
to ,
' THURSDAY to
k111)A/a// FRIDAY to
Please
Please Print Name Alb
*Nail Technicians are not currently required to obtain a personal rSATURDAY 1� to
license in the State of Connecticut. E/VE Make checks payable to:Town of South Windsor D
AUG 3
SOUTH
HFACTH ID SOR
Office Use Onl
Date Paid:t `-t Check Number: ' �`� Cash: Other: 'J$S "
Rev 7/5/18