The Northern Sierra Air Quality Management District has many forms that are specific to an applicant’s permittable activity. The forms presented below are all in pdf format. Please read the forms carefully. Be sure to include the appropriate application fee with any form submitted to the District. If you have any questions please do not hesitate to call either the main office in Grass Valley or one of our field offices. If you have any doubts as to whether or not you might need a permit, do not hesitate to contact one of our offices.

Authority to Construct for retail gasoline dispensing facility construction or modification. (fillable AC form for gas stations)

Carl Moyer Application Form - used by applicants wishing to participate in the Carl Moyer program.

DMV Surcharge Program Fund (AB 2766) - Forms for this program can be obtained by clicking here.

Permit Application Form for stationary sources (fillable Permit Application form) . To obtain the correct filing fee be sure to also download the Instructions for the Permit Application Form. See below for any Supplemental Forms that might also be necessary.

Soil Aeration / Remediation / Vapor Extraction Permit Application

Supplemental Forms (.pdf):

• Asbestos Dust Mitigation Plan Template - visit the California Air Resources Board web site to view the text of the Asbestos Air Toxic Control Measure.
• Asphalt Batch Plants
• Internal Combustion Engine - e.g. typically used for stationary or portable non-mobile engines running machinery or standby generators. Click here for a fillable pdf form.
• Sand & Gravel Crushing / Screening Plants

Upset / Breakdown Form for Stationary Sources (pdf or fillable pdf)

Variance Application for a Regular Variance ( pdf or fillable pdf)

Variance Application for a Short-term, Emergency or Interim Variance (pdf or fillable pdf)

Locations of Forms Not on this Page:

For the Smoke Management Plan form and the No Burn Day Authorization form, please go to our Open Burning page and read carefully the information found therein.