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Learn
how to apply for permits online.
Apply online!

Did you know you can apply for nine air permits online? Advantages of applying online include:

  • the process is secure; and
  • you can save your application and come back later to edit or submit it.
Contact information
For questions about Construction Permits, contact:
Dave Minkey
Air management engineer
920-662-5179
For questions about Operation Permits, contact:
Barbara Pavliscak
Operation permit manager
608-267-7540
For questions about Registration Permits, contact:
Alex Torres
Air management engineer
608-273-5605
For questions about General Permits, contact:
Tom Zelinski
Air management engineer
414-263-8577
For questions about compliance, contact:
Martha Makholm
Air management specialist
608-267-4231

Air permit and compliance forms

This page includes application forms for air permitting and some compliance/monitoring activities associated with air permitting. You can also learn how to apply for nine air permits online.

For permits, mail two copies of all completed application forms and materials to the following address:

Wisconsin Department Of Natural Resources
Bureau Of Air Management - AM/7
Construction Permits (and/or Operation Permits, as appropriate)
101 S Webster St
PO Box 7921
Madison WI 53707-7921

Please note: Many of our forms are available as "fillable" PDFs. It is best to save a copy of the form to your personal computer before you fill in any information. You will not be able to save the information you type into the form unless you have Adobe Acrobat (which is different than Adobe Reader).

Source specific

Source specific forms

These forms pertain to specific air pollution sources/emission units within a facility.

Form Number Form Name Word Document PDF Document
4530-100 Facility Details and Permit Actions - View instructions PDF
4530-101 Facility Plot Plan Word PDF
4530-102 Source and Site Descriptions Word PDF
4530-103 Stack Identification Word PDF
4530-104 Boiler or Furnace Operation Word PDF
4530-105 Storage Tanks Word PDF
4530-106 Incineration Word PDF
4530-107 Printing Operations Word PDF
4530-108 Painting and Coating Word PDF
4530-109 Miscellaneous Processes Word PDF
4530-110 Control Equipment Miscellaneous Word PDF
4530-111 Condensers Word PDF
4530-112 Adsorbers Word PDF
4530-113 Catalytic or Thermal Oxidation Word PDF
4530-114 Cyclone/Settling Chambers   PDF
4530-115 Electrostatic Precipitator Word PDF
4530-116 Wet Collection Systems Word PDF
4530-117 Baghouse/Fabric Filters Word PDF
4530-118 Compliance Certification - Monitoring and Reporting Methods Word PDF
4530-119 Continuous Emission Monitoring Word  
4530-120 Period Emission Monitoring Using Portable Monitors Word  
4530-121 Monitor Control System Parameters or Process Operating Parameters Word  
4530-122 Monitoring Maintenance Procedures Word  
4530-123 Stack Testing Word  
4530-124 Fuel Sampling and Analysis Word  
4530-125 Recordkeeping Word  
4530-126 Emission Unit HAP Summary Word  
4530-127 Facility HAP Summary Word  
4530-128 Emission Unit Summary Word  
4530-129 Facility Emissions Summary Word  
4530-130 Emission Requirements and Status of Unit Word  
4530-131 Emission Unit Compliance Plan Word  
4530-132 Emissions Requirements and Status of Facility Word  
4530-133 Facility Compliance Plan Word  
4530-135 Supplemental Information Word  

General and registration

General and registration forms

These forms pertain to general and registration permits and permit exemptions.

Form Number Form Name Document Contact
4530-141 to 144 Crushers General Operation Permits (GOP) A, B, C & Index Word Tom Zelinski
4530-156 Type A Registration Construction and Operation Permit Application PDF Alex Torres
4530-156A Type A Registration Construction and Operating Permit Modeling Assessment Attachment PDF Alex Torres
4530-157 Permit & Order Revocation for Registration or General Permits PDF Alex Torres
4530-163 Asphalt Plant General Construction Permit (GCP)/GOP (Draft) Word Tom Zelinski
4530-169 General and Registration Permit Petition PDF Kristin Hart
4530-172 Type C Registration Construction and Operation Permit for Printers Application PDF Alex Torres
4530-173 Printer General Construction/Operation Permit (GCP/GOP) Application (Draft) PDF Tom Zelinski
4530-183 Type B Registration Construction and Operation Permit Application PDF Alex Torres

Compliance

Compliance-related forms

These forms are related to compliance activities. All facilites which have been issued an air operation permit are required to submit an annual (or more frequent) compliance certification and compliance monitoring report to the DNR.

Form Number Form Name Documents Instructions & Examples
4500-025 Portable Source Relocation Notification PDF  
4500-125 Excess Emission Report for opacity Word  
4500-126 Excess Emission Report for gases Word  
4500-134 Fuel Sampling and Analysis Report Word  
4530-155 112(j) MACT Combined Parts 1 and 2 PDF
4530-184
(replaces Forms 4530-170 and 4530-171)
Air Operation Permit Compliance Certification & Deviation Summary Report PDF  
4530-175 Hot Mix Asphalt Plant GOP Combined Annual Monitoring Report and Certification of Compliance PDF  
4530-177 Nonmetallic Mineral Processing Plant GOP Combined Annual Monitoring Report and Certification of Compliance  
4530-178 Air Pollution Registration Operation Permit (ROP)
Section A - Annual Compliance Certification Monitoring Report
PDF PDF
4530-178A Air Pollution Registration Operation Permit (ROP)
Section B - Deviation Summary Report
4530-179 Registration Operation Permit (ROP)
Section C - Monitoring Summary/Checklist
PDF
4530-182 Air Permit Next Business Day Deviation
  Handling and Storage of Coal Certification Form Word see s. NR 445.10, Wis. Adm. Code
Last revised: Wednesday March 01 2017