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HomeMy WebLinkAbout2018 Application - Studio Nails �0*N Se4C Town of South Windsor — Health Department t� 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. Name of Establishment: Address of Establishment: Phone & E-mail of Establishment: c�' ' )�y`' - /y�� Name of Manager/Operator*: Phone Number for 24-hour Emergency Contact: Name of Legal Owner: 12��� Address for Legal Notices: (1114// ��' 41 G'f� License Fee: $50.00 per location Type of Services Provided: ❑ Barbering❑ Hairdressing E Nail Salon ❑ Cosmetology❑Threading ❑ Other Water Supply: © Public❑ Private (well) Sewage Supply: Q 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 p) 1p/11 TUESDAY C to Applicant Signature Date WEDNESDAY lII to , ' THURSDAY /�/�� to )/11 Please Print Name FRIDAY fNMto �i11 *Nail Technicians are not currently required to obtain a personal SATURDAY 11 b to k"' license in the State of Connecticut. F/VE Make checks payable to:Town of South Windsor D AUG 3 �U1? SOvrH H&I LtH,gip OR Office Use Only: 7. Date Paid: q_�`l Check Number: �`� Cash: Other: J Rev 7/5/18