Sch 6Form of permit application

Schedule 6—Form of permit application

Section 93(2)(a) of the Heritage Act 2017

Regulation 12

2. Pre-application details

Has the applicant had a pre-application discussion with Heritage Victoria in relation to this application? *Yes/*No

If yes, please provide the identifier provided for the pre‑application discussion (P number):

3. Applicant details

Details of owner or government asset manager of registered place or registered object

If the applicant is not the owner or the government asset manager (or acting on behalf of the owner or the government asset manager) details of the owner or government asset manager of the registered place or registered object:

4. Proposed works or activities

Type of permit

Provide a description of the proposed works or activities:

If the works or activities relate to part of the registered place or registered object only, indicate the part to which the proposed works or activities relate:

Reason and purpose for works or activities

State the reason and purpose for which the proposed works or activities are required:

Impact on heritage values

State the impact of the proposed works or activities on the heritage values of the registered place or registered object:

Are the proposed works or activities to be carried out entirely on Crown land?

Who is the responsible authority or, if the responsible authority is not the municipal council, the municipal council for the registered place or registered object?

$

5. Cultural heritage management plan

A Cultural Heritage Management Plan (CHMP) is a requirement of the Aboriginal Heritage Act 2006. It includes results of an assessment of the potential impact of a proposed activity on Aboriginal cultural heritage. It outlines measures to be taken before, during and after an activity in order to manage and protect Aboriginal cultural heritage in the activity area.

Is a CHMP required under the Aboriginal Heritage Act 2006 in relation to carrying out the proposed works or activities? *Yes/*No

Note: You can submit your application now and provide the approved CHMP later; however, a decision on your application cannot be made until you provide a copy of the CHMP. In accordance with section 52(3) of the Aboriginal Heritage Act 2006, a permit cannot be issued under the Heritage Act 2017 for works or activities that are inconsistent with an approved CHMP.