To: Independent Contractor -Cosmetology/Barbershops/Nail Salons From: Northeast District Department of Health
Date: November 13, 2025 Subject: 2026 Annual Permit

Fee: $135.00

The registration issued to your establishment by the Northeast District Department of Health (NDDH) will expire on December 31st and must be updated on a yearly basis. We are eager to assist you in complying with the State of Connecticut public health regulations.
Please return the following to this office by close of business Monday, December 15, 2025:

A completed Independent Contractor Service Application and Emergency Contact Information Form. You may access the application forms and can make payment online at www.nddh.org/formspermits/. If you do not have computer access, you may pick up the forms and pay the application fee at our office at 69 South Main Street, Brooklyn, during regular business hours (Monday-Thursday, 8am – 4pm, Fridays, 8am – noon).
Please be sure to provide us with a valid e-mail address, as we will be sending permits electronically.
The appropriate fee paid online at https://www.nddh.org/formspermits/pay-online/, brought to our office, or mailed with your application to 69 South Main Street, Unit 4, Brooklyn, CT 06234. The fee schedule, effective 7/1/25, can be found online at:
https://nddh.org/wp-content/uploads/2025/07/NDDH_Service_Fees_effective_070125.pdf

Upon receipt of all necessary documentation, a permit will be issued for your establishment which will be valid from January 1st through December 31, 2026.
All necessary documentation and permit fees must be received by close of business on Monday, December 15, 2025, or the establishment will be charged a late fee of $90. In addition, a penalty fee of $12 per NDDH business day with a maximum of $120 shall be assessed for each business day late from January 2 through January 15, 2026, inclusive.
Annual inspections will be conducted throughout the year. A re-inspection fee of $150 will be charged for a failed inspection.

Permit Checklist
Application
Emergency Form
Permit Fee Payment
Copy of License
Location Change (if applicable)

If you have any questions, please feel free to contact us. As always, we look forward to collaborating with you. Sincerely,
The Northeast District Department of Health

***EMERGENCY CONTACT INFORMATION***
Water Interruption • Power Outage • Fire • Flood • Contamination • Natural and Man-made Disasters
There are a number of emergencies that can interrupt your establishment. To protect the public, the Northeast District Department of Health (NDDH) must be able to quickly contact decision-makers for your business/organization to provide appropriate guidance. Check our website for regular updates that impact your establishment at https://www.nddh.org.
NDDH will conduct periodic tests of our Emergency Notification Systems. You may receive messages by phone, text, fax, or email. Please complete the information below, being sure to fill all fields accurately with contact information other than the owner.

Today’s Date: 	

Business/Org Name: 			 Business Address: 			  City: 	 State: 	 Zip: 		
Emergency Contact Name and Title: 		 Cell Phone: 	Fax Number: 		 Work Phone: 	 Home Phone: 		  Email Address: 				
Alternate Emergency Contact Name and Title: 		 Cell Phone: 	Fax Number: 	 Work Phone: 	 Home Phone: 	  Email Address: 				
Is water for your business establishment/organization supplied by:
	Well		Community Water System

NDDH USE ONLY:

Updated - EHS Database: 	 Excel Data Sheet:		Initials: 	

Businesses with multiple locations: Please complete a separate form for each location.

REVISED 10/27/2025