Forms
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 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 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 send completed applications either by:
- Email: office@myairdistrict.com
- Mail: NSAQMD, 380 Sierra College Drive, Suite 220, Grass Valley, CA 95945
- Submit below with required fields completed
Please complete when the facility’s contact information has changed to ensure the correct person is notified for any future permit or program updates. No fee is required for updates but please allow a few days from the District to make any changes.
Gas Dispense Facility - Transfer of OwnershipGas Dispense Facility - Facility Contact UpdateStationary Sources & Stationary Engine - Facility Contact Update
Records Request Form: To submit a request, complete the public records request form.
Public Records Request Form Policy
Fire Department Violation Worksheet
Dust Plan Approval Application
Internal Combustion Engine: Typically used for stationary or portable non-mobile engines running machinery or standby generators.
Two forms are needed to be submitted to deem the application process potentially complete with the filing fee payment: Permit Application Form AND Internal Combustion Engine Supplemental Form.
Follow the instructions on the Instructions for the Permit Application Form.
#1) Instructions for Permit Application
Instructions for Permit Application#2) Air Pollution Permit Application
Air Pollution Permit Application (Fillable)#3) Internal Combustion Engine Supplemental Form
ICE Supplemental Form (Fillable)Emergency Generator Reference: A quick and simple PDF that summarizes generator district regulation.
Northern Sierra Generator HandoutPlan Review Applications
Plan Review ApplicationPG&E Plan Review application
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 TemplatePlease reference our Planning page for more information about Asbestos.
Air Pollution Permit Application
No Burn Day Authorization
- No Burn Day Application
- Please Read Policy and Procedure for Issuing Authorizations to Burn on a No-Burn Day first or call the district.
Smoke Management Plan
Fee Schedule
Please visit our Open Outdoor Burning page for more information.
Permit Application Form: To obtain the correct filing fee be sure to also download the Instructions PDF. Some supplemental forms may be required.
#1) Instructions for the Permit Application Form
Instructions for the Permit Application#2) Permit Application Form
Permit Application (Fillable)Upset / Breakdown Form for Stationary Sources
Upset Break Down (Fillable)Variance Application for a Regular Variance
Variance Application (Fillable)Variance Application for a Short-term, Emergency or Interim Variance
Variance Application Short Term Emergency, (Fillable)
Soil Vapor Extraction Form: For soil contamination clean up projects.
Soil Vapor Application (Fillable)
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
