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.
Phone Number
Please enter a valid phone number.
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?*

YesNo
When was last permit received?
Have you had a fire permit revoked?*

YesNo
Please provide details on when fire permit was revoked and why.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*

YesNo
Number of People in attendance*
What type of fire breaks to be used? Minimum 4 metres to be cleared.*

PloughedChemicalOther
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.*

YesNo
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

Clear
Date

DayMonthYear
Date
Should be Empty:

APPLICANT DETAILS