Sch 4

Schedule 4

Regulation 139(1)

Permit for burning SPECIFIED MATERIALS or SUBSTANCES during a fire danger period

(Not valid on a day of TOTAL FIRE BAN or when the Chief Officer has issued a direction not to light a fire pursuant to section 37A of the Country Fire Authority Act 1958 which applies to the land)

PERMIT granted to [insert name] of

………………………………………………………..[insert address]

to light a fire or fires for the purpose of allowing the following specified material(s) to be burned: ……………………………………………………………..[describe materials or substances to be burned]

during the period commencing on [insert date] and ending on [insert date]

at

1. The holder of this permit must, on demand by the Chief Officer, the officer in charge of a brigade, a fire prevention officer, a municipal fire prevention officer, a forest officer, a police officer or a person authorised by the Chief Officer, produce this permit (or a copy of this permit) for inspection.

2. [Insert additional conditions, if any].

[Insert full name and title] …………………………………

of the ………………………. [insert name of Fire Authority or Municipal Council, or Administrative Unit or Public Authority, as applicable].

**Person authorised to grant this permit (Chief Officer/delegate, Fire Prevention Officer or Municipal Fire Prevention Officer).

| Notes:<br>Under section 38(3) of the Country Fire Authority Act 1958, a person to whom a permit is issued must comply with each of the conditions in the permit. Failure to comply with any condition is an offence.<br>Under section 38(4) of the Country Fire Authority Act 1958, compliance with the conditions of a permit does not of itself relieve the holder of a permit from liability for any damage sustained by another person as a result of any fire lit by the holder of the permit pursuant to that permit. |