What is the Gasoline Dispensing Facility Permit Application?

It is an air district permit application for gasoline dispensing facilities. It asks about the applicant, facility, project, tanks, dispensers, and vapor recovery equipment.

What attachments are required with the application?

The gasoline dispensing supplement must accompany a completed Authority to Construct and Permit to Operate application. The supplement instructs applicants to attach a site plan showing underground fuel and vapor lines and dispenser island locations.

Do I need a notary for the Gasoline Dispensing Facility Permit Application?

No. The signer certifies and dates the application without a notary. The form requests a site plan attachment, but does not identify any notarized or sworn attachment.

How do I submit the Gasoline Dispensing Facility Permit Application?

Send the application, supplement, applicable fees, and required information to the Lassen County Air Pollution Control District at 66 N Lassen Street, Susanville, CA 96130.

Susanville, CA · Lassen County

No notary required

Gasoline Dispensing Facility Permit Application

Gasoline facility owners or operators use this application to request air district permits for gasoline storage and dispensing equipment in Susanville.

What this form is

This application requests information for an Authority to Construct or Permit to Operate, including facility ownership, project details, equipment, tanks, dispensers, and vapor recovery systems. The gasoline dispensing supplement must accompany the completed permit application, and applicants are instructed to include a site plan showing underground fuel and vapor lines and dispenser island locations. The form lists an application fee and an evaluation fee.

Who needs it

Owners or operators proposing gasoline dispensing equipment, or seeking a permit for an existing unit, complete this application and its gasoline dispensing supplement.

How to submit it

Submit the application and applicable fees to the Lassen County Air Pollution Control District, 66 N Lassen Street, Susanville, CA 96130. The listed application fee is $56.75 plus an evaluation fee.

About notarization

This document is signed and dated without a notary; the signer certifies the application information, and the form requests a site plan attachment but no notarized or sworn attachment.

How to submit this form

1
Download The Application
Download the permit application and gasoline dispensing supplement.
2
Complete The Forms
Type or print the application in ink, provide the requested facility and equipment details, and sign and date the certification.
3
Gather Attachments
Include the required site plan showing underground fuel and vapor lines and dispenser island locations.
4
Submit To The District
Send the completed forms and applicable fees to the Lassen County Air Pollution Control District at the address listed on the application.

Frequently asked questions

What is the Gasoline Dispensing Facility Permit Application?: It is an air district permit application for gasoline dispensing facilities. It asks about the applicant, facility, project, tanks, dispensers, and vapor recovery equipment.
What attachments are required with the application?: The gasoline dispensing supplement must accompany a completed Authority to Construct and Permit to Operate application. The supplement instructs applicants to attach a site plan showing underground fuel and vapor lines and dispenser island locations.
Do I need a notary for the Gasoline Dispensing Facility Permit Application?: No. The signer certifies and dates the application without a notary. The form requests a site plan attachment, but does not identify any notarized or sworn attachment.
How do I submit the Gasoline Dispensing Facility Permit Application?: Send the application, supplement, applicable fees, and required information to the Lassen County Air Pollution Control District at 66 N Lassen Street, Susanville, CA 96130.

Need something notarized?

This Gasoline Dispensing Facility Permit Application doesn’t need a notary — but if you have another Susanville form that does, a commissioned online notary can help.