Fire Permit Application

Fire Permit Application
APPLICANT DETAILS
Name

First NameLast Name
Residential Address

Street Address

Street Address Line 2

CityState

Postcode
Postal Address

Street Address

Street Address Line 2

CityState

Postcode
Email
example@example.com
Mobile Number
Please enter a valid phone number.Format: 0000 000 000.
Phone Number
Please enter a valid phone number.Format: (00) 0000 0000.
BURN OFF DETAILS
Location of Proposed Burn
Section / Lot number, Hundred, Street.road name, rural property address
Description of Land, Vegetation & Size of Area to be Burnt
e.g.,100 hectares canola stubble in open paddock, rowed stubble, piles of tree branches
Time frame for Burn Off
Have you received a permit before?
When was last permit received?
Have you had a fire permit revoked?
Please provide details on when fire permit was revoked and why.
Do you have sufficient people attending to manage the burn off? Minimum of two people from ignition to extinguished
Number of People in attendance
What type of fire breaks to be used? Minimum 4 metres to be cleared.

Other
Details of other fire breaks being used.
Do you intend to take any other precautions? e.g. Burn small area at a time, two cfs brigades onsite.
Details of additional precautions
LODGEMENT
I {name} certify that to the best of my ability and knowledge, the information recorded on this application form is accurate.
Signature
Date

DayMonthYear
Date
Should be Empty:

APPLICANT DETAILS