City of Holyoke Board of Health

CITY OF HOLYOKE BOARD OF HEALTH

DATE: _____________________ FEE: $25.00

APPLICATION TO OPERATE A MANICURING ESTABLISHMENT IN THE

CITY OF HOLYOKE, MASSACHUSETTS

PURSUANT TO THE HOLYOKE BOARD OF HEALTH REGULATIONS ENTITLED MANICURIST SALON REGULATIONS: BOARD OF HEALTH REGULATIONS PERTAINING TO MANUCURISTS AND THE OPERATION OF MANICURING SALONS, SECTION 4, I HEREBY SUBMIT THIS APPLICATION TO OPERATE A MANICURING SALON.

OWNER INFORMATION

NAME OF SALON OWNER ________________________________________________________

HOME ADDRESS OF SALON OWNER _______________________________________________

CITY, STATE, ZIP OF OWNER ______________________________________________________

HOME TELEPHONE NUMBER OF OWNER ___________________________________________

SIGNATURE OF APPLICANT _____________________________________________________

ESTABLISHMENT INFORMATION

NAME OF SALON _______________________________________________________________

ADDRESS OF SALON ___________________________________________________________

CITY, STATE, ZIP OF SALON ______________________________________________________

TELEPHONE NUMBER ___________________________________________________________

NUMBER OF MANICURING STATIONS ______________________________________________

NUMBER OF MANICURISTS EMPLOYED _____________________

YOU HAVE INCLUDED COPIES STATE LICENSES FOR ESTABLISHMENT AND FOR EACH MANCURIST (WRITE YES OR NO)

PLEASE COMPLETE THIS APPLICATION AND RETURN IT ALONG WITH A CHECK MADE OUT TO THE CITY OF HOLYOKE FOR $50.00 TO THE HOLYOKE BOARD OF HEALTH OFFICE.

g.drive.application for nail salons