Application Forms for Title V and Non-Title V Facilities

Use our Application Matrix to determine which application forms are required. (Form Instructions)

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 Number Form Title Format
Non-Title V and Title V Forms
  Title V Permit Application Checklist

Administrative Application - Page 1

  • General Information

Administrative Application - 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

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

Modeling Request Forms (3 pages)

(Form Instructions)

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


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