LOCAL GOVERNMENT (MISCELLANEOUS PROVISIONS ACT) 1982 APPLICATION FOR

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Q Doc 139 Application for Registration of Persons Carrying On the Practice or Business of Acupuncture, Tattooing, Semi-Permanent Skin Colouring, Cosmetic Piercing and Electrolysis on their Premises

LOCAL GOVERNMENT (MISCELLANEOUS PROVISIONS ACT) 1982  APPLICATION FOR

Local Government (Miscellaneous Provisions Act) 1982

Application for Registration of Premises and Persons Carrying On the Practice or Business of Acupuncture, Tattooing, Semi-Permanent Skin Colouring, Cosmetic Piercing and Electrolysis

Particulars

  1. Address of premises to be registered:

…………………………………………………………………………………………………………….

…………………………………………………………………………………………………………….

2. Full name of Company and Registered Office (if applicable) applying to be registered:

…………………………………………………………………………………………………………….

…………………………………………………………………………………………………………….

3. Full name and address of person to be registered (home address will not be revealed on the certificate): .........................................................................................................

....................................................................................................................................................

....................................................................................................................................................

4. Telephone/mobile number: ....................................................................................

5. Email:…………………………………………………………………………………………………….

6. Type of work to be undertaken by applicant (please tick relevant box):

Acupuncture Semi-permanent skin colouring Ear Piercing Only

Electrolysis Tattooing *Cosmetic Piercing

*Please specify type of piercing to be undertaken: ................…………………………….....…….

7. Have you previously been registered with this or any other authority?

Yes No

If ‘Yes’, which? ............................................................................................................................

8. Have you ever been convicted of any offence under section 16 of the above Act relating to skin piercing activities (this information subject to the Rehabilitation of Offenders Act 1974)?

Yes No

9. Do you have a trade waste contract?

....................................................................................................................................................

....................................................................................................................................................



10. Do you have a contact for the safe disposal of clinical waste such as sharps?

……………………………………………………………………………………………………………

Fees

Payment can be made by either credit or debit card by telephoning 01706 217 777 (option 7), or by calling with your completed application to the One Stop Shop at the address below.

Important note: we do not accept cash payments.

Once you have paid the above fees and emailed your completed application form, an Environmental Health Officer will be in touch to arrange a suitable date and time to visit and undertake an inspection.

Rossendale Borough Council

Public Protection Unit
Business Centre
Futures Park
Bacup
Lancashire OL13 0BB

Email: [email protected]

I declare that the above is true and undertake to inform the Council immediately of any change in circumstances.



Signed:…..……………………………………………………………….… Date:…..………………………




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