Online Form - Fire Permit Request » Shire of Wyndham-East Kimberley

The following supporting information, along with a map of the proposed area to be burnt, is required before a Fire Permit can be issued. Fire permit requests must be submitted 48 hours prior to the requested date.

Applicant Details

Full Name*

Company name (If applicable)

Land Title Holder

Postal Address

Postal Address:*

City:*

State:*

Post Code:*

Country:*

Residential Address

Residential Address:*

City:*

State:*

Post Code:*

Country:*

Contact Number - HOME

Contact Number - MOBILE*

Contact Number - WORK

Email*

Preliminary Information

Maximum period - 28 days

Start Burn Date*

End Burn Date

Durations (hrs/days)*

Area (ha)*

Description of area to be burnt including specific address*

What alternatives have been considered to burning off? why aren't these viable options?*

When was this area last burnt?*

Proximity and description of nearby land uses*

Burn Objectives

Tick as appropriate

Fire Suppression Equipment

Please ensure you enter quantity and water capacity/notes on the equipment you will be using.

Suppression - Heavy Tanker : please enter Quantity and Water Capacity/Notes*

Suppression - Light Tanker : please enter Quantity and Water Capacity/Notes*

Suppression - Vehicle Mount (slip on) tank & pump unit : please enter Quantity and Water Capacity/Notes*

Suppression - Trailer mount tank & pump unit : please enter Quantity and Water Capacity/Notes*

Suppression - firefighting backpack : please enter Quantity and Water Capacity/Notes*

Suppression - Grader/Bulldozer : please enter Quantity/Notes*

Suppression - Others (please specify)

Communications - Radios : please enter Quantity/Notes*

Communications - Satellites phones : please enter Quantity/Notes*

Communications - Mobile phones : please enter Quantity/Notes*

Burn Monitoring Equipment - Anemometer (Kestrel or similar) : please enter Quantity/Notes*

Burn Monitoring Equipment - GPS : please enter Quantity/Notes*

Personnel

Personnel required - minimum of 3

Number of personnel present for entire burn*

Notification

Below are the contacts of Stakeholders and the method of notification required:
Shire of Wyndham East Kimberley | Rangers | Telephone: 08 9168 4166
DFES | Regional Ops Centre | 1800 198 140

Please provide below contact of neighbouring properties and their preferred notification method.

Please enter Neighbouring Properties (North) owner/Tennant*

Did you contact them by phone or in person:*

Please enter Neighbouring Properties (South) owner/Tennant*

Did you contact them by phone or in person:*

Please enter Neighbouring Properties (East) owner/Tennant*

Did you contact them by phone or in person:*

Please enter Neighbouring Properties (West) owner/Tennant*

Did you contact them by phone or in person:*

Burning Prescriptions

Specific details of what you are burning*

Site Risks

Containment / Firebreak / Wind

Please provide as much information as possible regarding Area, Type (Slashed, Ploughed, Mineral Earth) and size (meters)

North Area - please provide type and size*

South Area - please provide type and size*

East Area - please provide type and size*

West Area - please provide type and size*

Others (please specify)

Wind strength not to exceed 20km/h - add specific details if you want to exceed 20km/h

Map

PLEASE ATTACH A DETAILED MAP OF YOUR PROPOSED BURN BELOW.
A detailed map should include the following:
- Aerial image with boundaries/breaks clearly outlined
- GPS co-ordinates specified
- Adjacent roads highlighted

Please upload map below*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Conditions

Please note that this consent is granted with the following conditions:

1) Permit valid for the purposes, dates and areas in this application only
2) No responsibility will be accepted by the Shire for any damage caused
3) Consent maybe withdrawn by the Shire at any time
4) The permit holder indemnifies the Shire against any claim for personal injury, damage or any other loss arising howsoever from said fire use

Please type your name below to signify that you agree that all information given above is true and correct at the time of submission*

Date*

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