Schedule Sch 1B - Heritage Regulations 2017 - Form of application for an exclusion determination that a place or object not be included in the Heritage Register | Zoe
Schedule 1B—Form of application for an exclusion determination that a place or object not be included in the Heritage Register
Section 36A(2)(a) of the Heritage Act 2017
Regulation 6C
Applicant's details
If applicant is a Department Head or Administrative Office Head:
Title:
If applicant is a government asset manager or public authority:
Name of *Minister/*entity/*public authority:
If a person is applying on behalf of the applicant:
Details of person who prepared application (if not the applicant)
If acting on behalf of a body corporate or organisation:
Name of body corporate or organisation:
Details of owner or government asset manager of place or object
If the applicant is not the owner or government asset manager of the place or object (or acting on behalf of the owner or the government asset manager), details of the owner or government asset manager:
Has the applicant had a pre-application discussion with Heritage Victoria in relation to this application?
If yes, please insert the pre-application reference number:
Major development
Provide a brief description of the major development to which the application relates:
Estimated cost of the major development
$
Note: The cost of the major development must be at least $5 million.
Impact of major development on place or object
Explain the potential impact of the major development on the place or object.
Details of the place or object
Type
*Place/*object:
Location
Name of the *place/*object:
Address of place or object:
Who is the responsible authority or, if the responsible authority is not the municipal council, the municipal council for the place or land on which the object is located:
Heritage Inventory number (if any):
National Trust reference number (if known):
Has the place or object previously been identified in a heritage study? *Yes/*No
Local Heritage Overlay information if place
Does this place have a local Heritage Overlay (HO) within a planning scheme? *Yes/*No
If yes, please provide the HO number:
Extent of place or object
*Briefly describe the object/s and their nature.
Note: If your application relates to an object or collection of objects, you must provide an inventory that includes the details below for each object including each object within a collection.
*Briefly describe the extent of the place and what it includes and if you are including part of a land parcel, please describe that part. You may refer to title details, an extent diagram or physical landmarks, etc.
Is the proposed major development to be carried out entirely on Crown land?
Heritage Council assessment criteria
Assessment of State-level cultural heritage significance
Include reasons why the place or object should not be included in the Heritage Register. These must be reasons based on the assessment against all criteria published by the Heritage Council. This means you must provide reasons why the place or object does not meet the threshold of State‑level cultural heritage significance in relation to each of the criteria.
For further information on the Heritage Council assessment criteria and thresholds please refer to website of the Heritage Council.
Other information
Note: Information in this section should provide evidence as to why this place or object has no reasonable prospect of inclusion in the Heritage Register. Information should be based on robust research and analysis. Exclusion determinations can be overturned if significant new information is identified.
Physical description
Please describe the place or object, identifying any elements referred to in the assessment of State-level cultural significant significance.
History of the place or object
Please provide a comprehensive history of the place or object which explores its historical associations and details its development over time.
Comparative analysis
Provide comparisons to similar places or objects recorded in the Heritage Register relevant to State-level cultural heritage significance or to places and objects where a determination has been made not to include them in the Heritage Register.
Aboriginal cultural heritage values (if known)
Who are the traditional owners of the place or object (if known)?
Does this place or object have Aboriginal cultural heritage values? *Yes/*No
If yes, please provide details below.
Note: If the place or object is of cultural heritage significance only on the grounds of its association with Aboriginal tradition, Aboriginal traditional use, or Aboriginal archaeology, it may be appropriate for consideration for the Victorian Aboriginal Heritage Register. Please refer to the website of the Victorian Aboriginal Heritage Register.
Please list the key sources relied on in your assessment. This could include books, publications, websites, the names of experts or any other resources.
Condition, intactness and integrity of the place or object
Condition
The condition of the place or object is generally: *Excellent/*Good/*Fair/*Poor
Is there any damage to the fabric (the materials from which the place or object is made)? *Yes/*No
If yes, please specify which materials and the extent of damage.
Intactness and integrity
How much of the original form or appearance of the place or object remains?
What alterations are present and why was the place or object altered?
Have the changes or alterations affected the heritage value of the place or object?
Supporting documents
• copy of the certificate/s of title issued within 30 days before this application is lodged (not necessary for places located entirely on Crown land or if nominating objects only);
• recent photographs of the place or object. You may include historical photographs as well;
• a simple and accurate extent diagram clearly showing the extent (boundaries) of the place or object subject to this exclusion determination application;
Note: This may take the form of spatial files or a copy of an existing map or plan with a clear hand drawn line around the extent showing the land, buildings and other key features.
• if your application relates to a collection of objects,
an inventory of the objects.
Applicant statement
I state that the application has been made to facilitate a major development costing at least $5 million.
Name of *applicant/*person applying on behalf of applicant:
Sch. 2 substituted by S.R. No. 3/2024 reg. 16, amended by S.R. No. 13/2025 reg. 13.