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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. City*
11. State/Province/Region*
13. Postal/Zip Code*
14. Country*
16. Property Owner Name*
18. Business/Contractor Name*
20. Business/Contractor Address*
22. City*
23. State/Province/Region*
25. Postal/Zip Code*
26. Country*
28. Business/Contractor Phone Number*
30. Individual in Charge of Site*
32. Site Contact Phone Number*
34. Email*
36. Scope of Work*

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

38. Upload Plans/Drawings
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field