Indoor Tanning Permit Issuing Officials
The New York State Department of Health Herkimer District Office is responsible for the implementation of the Tanning Facility Program in:
- Fulton County
- Herkimer County
- Montgomery County
Permit Requirements
- DOH 3915: Application for a Permit to Operate (PDF, 103KB, 4pg.)
- DOH 4494: Tanning Facility Fee Determination Schedule (PDF, 60KB, 1pg.)
- Application Checklist (PDF, 50KB, 1pg.)
Other Required Information and Forms
- Tanning Hazards Information Sheet
- Tanning Facility Statement of Acknowledgement Form
- Tanning Facility Parental Consent Form
- Warning Sign (PDF, 72KB, 1pg.)
- Injury and Illness Report Form (PDF, 79KB, 1pg.)
Contact Information
Download and complete forms DOH 3915, DOH 4494 and the Application Checklist and mail to:
New York State Department of HealthHerkimer District Office
5665 State Route 5
Herkimer, New York 13350-9721
(315) 866-6879
