Applicant Details
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1. Telephone Must be 24 hour availability
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2. Applicant: (name of Company, Statutory Corporation, Municipal Council, or individual and where relevant, the applicant’s ABN/ACN/ARBN)
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3. Authorised representative: The person who will have oversight of the work conducted using the permit
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4. Job title of authorised representative:
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5. Email address
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6. Address of applicant: Must be a physical address
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Street Address
Town/Suburb:
Postcode:
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Description of Work
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6. Type of work to be carried out: (tick)
□ Welding, cutting or grinding
□ Heating & spreading of bitumen
□ Diesel or gas powered steam cleaner
□ Blow lamps, gas torches
□ Gas flare-off
□ Carry out blasting
□ Aerodrome Flares
□ Petroleum Flares
□Industrial heat testing
□Destroying medical waste
□Working with bees
□Catering
□Public fireworks (please provide Worksafe license number)
□Sawdust burner
□Hot air ballooning
□Religious or Cultural Purposes
□Other
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If ‘other’, please describe:
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7. What will fuel the fire?: (eg)
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Flammable liquid
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Gas
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Electricity
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Oils and/or fats
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Please describe:
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8. Location at which the work will be done
If multiple locations, please list each one. If you are a state-wide operator, please write ‘state-wide’.
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9. Period for which permit sought
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10. Explain why the use of fire in the open air on a day of Total Fire Ban is necessary
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Permit conditions and Applicant’s acknowledgments
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Please confirm acceptance
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11. The applicant acknowledges that conditions will apply if a Permit is granted. The applicant agrees to abide by these conditions and is aware that any permit granted may be revoked.
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12. The applicant acknowledges that failure to comply with every condition contained in any permit issued is an offence under section 40(9) of the Country Fire Authority Act 1958.
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13. The applicant acknowledges that if a permit is issued, the permit will only apply in that area defined as the Country Area of Victoria and is not valid in the Metropolitan Fire District or within any National Parks or Protected Public Land or within any fire protected area under the Forest Act 1958.
NOTE: Parts of Greater Melbourne fall within the Country Area of Victoria. Please check the boundary on the orange key maps at the front of a Melways street directory or contact CFA on (03) 9262 8444 if you require more information.
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14. The applicant acknowledges that the Country Fire Authority will assess this application, and may determine not to issue a permit.
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15. Applicant signature
Individual……………………………………………………………...Date………………….……………………………
Company, Statutory Corporation or Municipal Council
Signed by a director or authorised officer of the Applicant:
Signature………………………………………………………………Date………………….……………………………
Full name…………………………………………………………………………………………………………..…………
Address……………………………………………………………………………………………………………………….
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