Skip to main content

Forms

Find A Form

Please do not submit ANY forms with ANY payment without first contacting the Air District to verify that you actually need a permit. Reimbursing payments made in error is a lengthy, expensive and unnecessary process.

Most applications have an associated fee, please see below for the current fee schedule or contact District Staff is you have any questions. Fees are updated annualy July 1.

Click here for the current fee schedule

Please read the forms carefully, and be sure to include the appropriate application fee with any form submitted to the District. Fillable PDF Forms are not supported by all browsers. If you have trouble, try downloading and opening them in Acrobat Reader or other PDF viewer.  Optionally, you can try a different browser.

Please sent completed applications either by: 

  • Email: office@myairdistrict.com
  • Mail: NSAQMD, 200 Litton Drive, 320 Suite, Grass Valley, CA 95945
  • Submit below with required fields completed

SUBMIT
There was a problem saving your submission. Please try again later.
Please wait while your submission is being saved...
Thank you, your submission has been received.

 

Asbestos Dust Mitigation Plan 

Asbestos Dust Mitigation Plan Template: Visit the California Air Resources Board web site to view the text of the Asbestos Air Toxic Control Measure (ATCM)

Asbestos Dust Mitigation Plan Template

Please reference our Planning page for more information about Asbestos. 

County, Fire Department, Dust Plans and Misc Documents 

Fire Department Violation Worksheet

Dust Plan Approval Application 

Internal Combustion Engine 

Internal Combustion Engine: Typically used for stationary or portable non-mobile engines running machinery or standby generators. When submitting this form you will also need to fill out a Permit Application Form and follow the instructions on the Instructions for the Permit Application Form. 

Instructions for Permit Application

Instructions for Permit Application

Air Pollution Permit Application

Air Pollution Permit Application (Fillable)Air Pollution Permit Application

Internal Combustion Engine Supplemental Form

ICE Supplemental Form (Fillable)ICE Supplemental Form 

Emergency Generator Reference: A quick and simple PDF that summarizes generator rules

Northern Sierra Genrator Handout
Public Records Requests 

Records Request Form: To submit a request, complete the public records request form. 

Public Records Request Form Policy

 

Stationary Sources 

Permit Application Form: To obtain the correct filing fee be sure to also download the Instructions PDF. Some supplemental forms may be required.

Instructions for the Permit Application Form

Instructions for the Permit Application

 Permit Application Form 

Permit ApplicationPermit Application (Fillable

Upset / Breakdown Form for Stationary Sources

Upset Break Down (Fillable)Upset Break Down

Variance Application for a Regular Variance

Variance  Application - Regular (Fillable)Variance  Application - Regular

Variance Application for a Short-term, Emergency or Interim Variance

Variance Application - Emergency Short Term Interim (Fillable)Variance Application - Emergency Short Term Interim

 

Soil Aeration / Remediation / Vapor Extraction Projects 

    Soil Vapor Extraction Form: For soil contamination clean up projects. 

    Soil Vapor Application (Fillable)

     

    Vapor Recovery 

    All new facilities (both retail and non-retail) and all major modifications to existing facilities must be done under the authority of an Air District permit: 

    Vapor Recovery - ATC

     

    Join our mailing list