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Application for a Tattoo/Body Piercing Shop Certificate of Sanitation

  1. letterhead top bar.bmp

  2. 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. 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. Water Supply - A*

  7. Water Supply - B*

  8. Sewage System *

  9. List days of week and hours

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

  11. Leave This Blank: