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 (.doc)  
AA (Instructions Included) Administrative Application (General Information) (page 1)
Administrative Application (continued) (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

NOTE: You now can fill in, save, and print Form AA using the free Adobe Reader.

A1 Facility General Information (.xls) (.pdf)
A2 Emission Source Listing for this Application (.xls) (.pdf)
A3 112(r) Applicability Information (.xls) (.pdf)
B Specific Emission Source Information (Required for all Emission Sources) (.xls) (.pdf)
B1 Emission Source (Wood, Coal, Oil, Gas, Other Fuel-fired Burner) (.xls) (.pdf)
B2 Emission Source (Internal Combustion Engines / Generators) (.xls) (.pdf)
B3 Emission Source (Liquid Storage Tank) (.xls) (.pdf)
B4 Emission Source (Woodworking) (.xls) (.pdf)
B5 Emission Source (Coating / Finishing / Printing) (.xls) (.pdf)
B6 Emission Source (Storage Silo / Bins) (.xls) (.pdf)
B7 Emission Source (Manufacture of Chemicals / Coatings / Inks) (.xls) (.pdf)
B8 Emission Source (Incineration) (.xls) (.pdf)
B9 Emission Source (Other) (.xls) (.pdf)
C1 Control Device (Fabric Filter) (.xls) (.pdf)
C2 Control Device (Electrostatic Precipitator) (.xls) (.pdf)
C3 Control Device (Thermal of Catalytic) (.xls) (.pdf)
C4 Control Device (Cyclone, Multicyclone, or Other Mechanical) (.xls) (.pdf)
C5 Control Device (Adsorber) (.xls) (.pdf)
C6 Control Device (Gaseous Absorber) (.xls) (.pdf)
C7 Control Device (Condenser) (.xls) (.pdf)
C8 Control Device (Wet Particulate Scrubber) (.xls) (.pdf)
C9 Control Device (Other) (.xls) (.pdf)
D1 Facility-Wide Emissions Summary (.xls) (.pdf)
D2 Air Pollutant Netting Worksheet (.xls) (.pdf)
D3 Modeling Request Forms (three pages)   (.pdf)
D3 Instructions for Modeling Request Forms   (.pdf)
D4 Exempt and Insignificant Activities Summary (.xls) (.pdf)
D5 Technical Analysis to Support Permit Application (includes P.E. Seal Form) (.xls) (.pdf)
D6 Modeling Protocol Checklist   (.pdf)
Title V Only Forms
A1-MINOR  New Title V Minor Modification (Prior to Permit Revision) (.xls) (.pdf)
E1 Title V General Information (.xls) (.pdf)
E2 Emission Source Applicable Regulation Listing (.xls) (.pdf)
E3 Emission Source Compliance Method (.xls) (.pdf)
E4 Emission Source Compliance Schedule (.xls) (.pdf)
E5 Title V Compliance Certification (.xls) (.pdf)
E6 Compliance Assurance Monitoring (CAM) Plan (.doc) (.pdf)
Title V Notification Form
   New 502(b)(10) Change Notification Form (.xls) (.pdf)


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