Application Forms for Air Quality Permit to Construct/Operate Non-Title V and Title V Facilities

Use our Application Matrix to determine which application forms are required.

A $25.00 processing fee will be charged for returned checks in accordance with the North Carolina General Statue 25-3-512

Submit, to the appropriate NC DAQ regional Office, the following number of permit applications and supporting data:

  • Two (2) copies for Non-Title V Facilities
  • Three (3) copies for Title V Facilities
  • Six (6) copies for Title V Facilities subject to NCAC 2D.0530, .0531, or 1200, plus one additional copy for each affected State
  • Three (3) copies of any modeling analysis/report and one (1) copy of the modeling files
Form Title Format
  Title V and Non-Title V Form Instructions (.docx)
Application Checklists
  Title V Permit Application Checklist (.docx) (.pdf)
  Non-Title V Permit Application Checklist (.docx) (.pdf)
Non-Title V and Title V Forms

General Facility Information - Page 1

  • General Information
  • NEW: ePayment Option Included

General Facility Information - Page 2

  • Section AA1 - Application for Non-Title V Permit Renewal
  • Section AA2 - Application for Title V Permit Renewal
  • Section AA3 - Application for Name Change
  • Section AA4 - Application for Ownership Change
  • Section AA5 - Application for an Administrative Amendment
A2, A3

A2 - Emission Source Listing for this Application

A3 - 112(r) Applicability Information

(.xlsx) (.pdf)
B Specific Emission Source Information (Required for all Sources) (.xlsx) (.pdf)
B1 Emission Source (Wood, Coal, Oil, Gas, Other Fuel-fired Burner) (.xlsx) (.pdf)
B2 Emission Source (Internal Combustion Engines / Generators) (.xlsx) (.pdf)
B3 Emission Source (Liquid Storage Tank) (.xlsx) (.pdf)
B4 Emission Source (Woodworking) (.xlsx) (.pdf)
B5 Emission Source (Coating / Finishing / Printing) (.xlsx) (.pdf)
B6 Emission Source (Storage Silo / Bins) (.xlsx) (.pdf)
B7 Emission Source (Manufacture of Chemicals / Coatings / Inks) (.xlsx) (.pdf)
B8 Emission Source (Incineration) (.xlsx) (.pdf)
B9 Emission Source (Other) (.xlsx) (.pdf)
C1 Control Device (Fabric Filter) (.xlsx) (.pdf)
C2 Control Device (Electrostatic Precipitator) (.xlsx) (.pdf)
C3 Control Device (Thermal or Catalytic Oxidizer) (.xlsx) (.pdf)
C4 Control Device (Cyclone, Multicyclone, or Other Mechanical) (.xlsx) (.pdf)
C5 Control Device (Adsorber) (.xlsx) (.pdf)
C6 Control Device (Gaseous Absorber) (.xlsx) (.pdf)
C7 Control Device (Condenser) (.xlsx) (.pdf)
C8 Control Device (Wet Particulate Scrubber) (.xlsx) (.pdf)
C9 Control Device (Other) (.xlsx) (.pdf)
D1 Facility-Wide Emissions Summary (.xlsx) (.pdf)
D2 Air Pollutant Netting Worksheet and Facility-wide Emission Summary (.xlsx) (.pdf)
D2A Air Pollutant "Project Only" Netting Worksheet (.xlsx) (.pdf)

Modeling Request Forms (3 pages)

(Form Instructions)

(.xlsx) (.pdf)
D4 Exempt and Insignificant Activities Summary (.xlsx) (.pdf)
D5 Technical Analysis to Support Permit Application (includes P.E. Seal Form) (.xlsx) (.pdf)
D6 Modeling Protocol Checklist (.xlsx) (.pdf)
Title V Only Forms
A1-MINOR Title V Minor Modification (Prior to Permit Revision) (.xlsx) (.pdf)
E1 Title V General Information (.xlsx) (.pdf)
E2 Emission Source Applicable Regulation Listing (.xlsx) (.pdf)
E3 Emission Source Compliance Method (.xlsx) (.pdf)
E4 Emission Source Compliance Schedule (.xlsx) (.pdf)
E5 Title V Compliance Certification (.xlsx) (.pdf)
E6 Compliance Assurance Monitoring (CAM) Plan (.xlsx) (.pdf)
Title V Notification Form
  502(b)(10) Change Notification Form (.xlsx) (.pdf)