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Application for a Tattoo/Body Piercing Shop Certificate of Sanitation

  1. letterhead top bar.bmp

  2. Application Fee - $150.00

    Operation of a tattooing or body piercing shop without certification is a violation of Article XIII of the Sanitary Code of the Chautauqua County Health District.

  3. Instructions

    Submit at least 30 days prior to first day of operation or at least 15 days prior to the expiration of a current certification. False statements on this application may be cause for certification revocation.

  4. A. APPLICATION TYPE*

  5. B. SHOP TYPE*

    Check all that apply

  6. C. SHOP INFORMATION

  7. Water Supply - A*

  8. Water Supply - B*

  9. Sewage System *

  10. List days of week and hours

  11. E. OWNER/OPERATOR INFORMATION

  12. Application Fee $150.00 ~ Make checks payable to: Director of Finance

    CCDOH, Environmental Div, HRC Building, 7 North Erie Street, Mayville, NY 14757

  13. Leave This Blank: