Fee for new applications: $100
Fee for renewals: $35

Application type: New - $100 Renewal - $35

Business name:

Please use the following dropdown to select the business address from our GIS database

Business location: Business phone number: Business suite or floor number:

The `Owner Email Address` is the email the Town of Manchester will use to correspond with. The `Business Email Address` will be kept for reference.

Business email address: Business hours of operation:

Please describe the nature or type of massage to be administered/Other services provided

Service description:

Please provide written procedures for cleaning and disinfecting equipment, utensils, and laundry/linens

Cleaning procedures:

Please upload all specification sheets for tubs/steam baths/shower tables etc.

Specification sheets:

Please provide a detailed floor plan of the establishment showing the following:

Each client must have privacy

The massage therapists must have access to a hand wash sink and a mop sink

A utility sink may be required depending on equipment and/or utensils, used in the practice of massage, that need to be cleaned and disinfected

A chemical storage area

A clean linen storage area

A soiled linen storage area (separate containers are required for clean and soiled linens)

A single use item storage area

Floor plan:

Owner name: Owner date of birth: Owner address: Owner city: Owner state: Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Owner zip code:

The `Owner Email Address` is the email the Town of Manchester will use to correspond with. The `Business Email Address` will be kept for reference.

Owner email address: Owner cell phone number: Owner's drivers license:

Please upload photocopies of employees’ State of Connecticut Massage Therapist licenses and current CT driver’s licenses

Files:

By submitting this application I authorize the Director of Health to seek information and conduct an investigation into the truth of the statements set forth in this application and my qualifications for this permit. I understand that the Director of Health may require that I furnish any other identification and information necessary to discover the truth of the matter hereinbefore specified as required to be set forth in this application. I agree to operate this massage therapy establishment in accordance with the Town of Manchester Massage Establishment Ordinance. I understand that, as the applicant, I am responsible for the massage therapy establishment. I understand that any questions not answered or any false or misleading answers contained herein shall be grounds for immediate rejection of this application or closure of the massage therapy establishment registered hereunder.