HomeMy WebLinkAbout2018 Application - Paulies ta�N sf,� Town of South Windsor — Health Department
1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address
1530 Sullivan Avenue, South Windsor, CT 06074 — Office Address
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. 1, 7
Name of Establishment: hau ILc;S i'1"O�e SS101'�GCS Il rSh�(�
Address of Establishment: `iw5 QUL CL.YI c) RO c) th V4i' lch,Of i
/
Phone & E-mail of Establishment: l� 43) — cl 1(I 3
Name of Manager/Operator*: _PG-V�1 L a Chanct,
Phone Number for 24-hour Emergency Contact: N 0 �S 4
Name of Legal Owner: �Gt U I LCl C.h ar\( ems
Address for Legal Notices: 1 Al (ki 0 h d
�OOat1l W f 0 d b 0 r 47
License Fee: $50.00 per location
Type of Services Provided: Barbering❑ Hairdressing❑ Nail Salon El cosmetology❑Threading
6 Other
Water Supply: VJ Public ❑ Private (well) Sewage Supply: 71 Public❑ Private (septic)
Is food or beverage provided for the public on site? ❑ YES [ NO HOURS OF OPERATION
If YES, plea a ribe: SUNDAY !to
MONDAY
TUESDAY to
11
Appli nt Signatu Da a WEDNESDAY to
THURSDAY to
-Pau ! L a Lh G h c_c_..
FRIDAY to
Please Print Name
*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