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2. Notice

   No permit will be issued until the $50 fee is received. Please make checks or money orders payable to "County of Henry" and send to:
   Henry County Fire Marshal's Office
   1024 DuPont Road
   Martinsville, Virginia 24112

4. Type of Storage Tank

   1. Above Ground
   2. Below Ground
6. Scope*

   1. Abandon In-Place
   2. Installation
   3. Removal
8. Job Site Address*
10. Site Address*
12. City*
13. State/Province/Region*
15. Postal/Zip Code*
16. Country*
18. Property Owner Name*
20. Business/Contractor Name*
22. Business/Contractor Address*
24. City*
25. State/Province/Region*
27. Postal/Zip Code*
28. Country*
30. Business/Contractor Phone Number*
32. Individual in Charge of Site*
34. Site Contact Phone Number*
36. Email*
38. Scope of Work*

    Give a brief description of the work being performed at the above site.

40. Upload Plans/Drawings
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field