HomeMy WebLinkAbout2018 Application 2 - The Residence sown 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: Residence at South Windsor Farms
Address of Establishment: 200 Deming ' e• South Windsor CT
Phone&E-mail of Establishment: $60-432-2911
Name of Manager/Operator": Healthcare Cosmetology
Phone Number for 24-hour Emergency Contact:
Name of Legal Owner: South Windsor Farms OPCO.LLC
Address for Legal Notices: 3 Edeewater Drive,Stir 10 1
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
17Z
TUESDAY gam t0 2pm
Appl nt Signature ate WEDNESDAY to
THURSDAY gam to 2pm
Please Print Name r FRIDAY to
*Nail Technicians are not currently required to obtain a personal SATURDAY to
license in the State of Connecticut.
Make checks payable to:Town of South Windsor
OCT 2 5
SOUTH WINDSOR
Office Use Only: HEALTH DEPT.
Date Paid: 15U Check Number: 11`7_ Cash: Other: _
Rev 7/5/18