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*
YesNo
When was last permit received?
YesNo
Please provide details on when fire permit was revoked and why.
YesNo
Number of People in attendance*
PloughedChemicalOther
Details of other fire breaks being used.
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