Permit - Fumigation and Thermal Insecticidal Fogging

Notice*
No permit will be issued until $50.00 fee is recieved. 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
Business/Company Name
Fumigation Site Address Fumigation Site Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Business/Company Phone Number Business/Company Phone Number - ### - ### ####
Contractor Performing Fumigation
Contractor Address Contractor Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contractor Phone Number Contractor Phone Number - ### - ### ####
Individual in Charge of Fumigation
Liscense # for Individual Conducting Fumigation
Individual in Charge Phone Number Individual in Charge Phone Number - ### - ### ####
Individual in Charge Email
Fumigation Begin Date Fumigation Begin Date / MM / DD YYYY
Fumigation Begin Time Fumigation Begin Time : HH MM AM/PM
Fumigation End Date Fumigation End Date / MM / DD YYYY
Fumigation End Time Fumigation End Time : HH MM AM/PM
List of Chemicals