ACT HERITAGE ACT
					AF2014-110
For ACT Heritage Use Only	
Date received		
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Accepted?		

ACT HERITAGE ACT—
APPLICATION FOR APPROVAL OF A CONSERVATION MANAGEMENT PLAN
Heritage Act 2004, s61J

The ACT Heritage Act 2004 (the Act) establishes a system for the recognition, registration and conservation of places and objects having heritage significance and for all Aboriginal places and objects. 

Under sections 74 and 75 of the Act, a person commits an offence if the person engages in conduct that diminishes the heritage significance of a place or object, or if the person engages in conduct that causes damage to an Aboriginal place or object.

However, under s76 of the Act, such conduct is not an offence if carried out in accordance with any of the following:
•	A heritage guideline;
•	A heritage direction;
•	A heritage agreement;
•	A conservation management plan approved by the Council;
•	An excavation permit;
•	A Statement of Heritage Effect approved by the Council;
•	Development approval under the Planning and Development Act 2007 chapter 7; or
•	If the person is a government officer exercising a function for the Heritage Act or another Territory law or engaging in authorised conduct.

This form may be used to seek the Council’s approval of a Conservation Management Plan (CMP).

A person or entity responsible for the place or object may make an application for approval of a CMP. No fee is payable by private property owners for seeking approval of a CMP. An application will not be accepted unless signed and dated.

The ACT Heritage Council will notify you as soon as possible about its acceptance or dismissal of this application. A CMP may be approved with conditions.

DO YOU REQUIRE MORE INFORMATION OR NEED HELP?
If you need help completing this form, contact ACT Heritage on 13 22 81 or
email heritage@act.gov.au. Incomplete or inadequate forms will be returned with feedback.

More information about the ACT Heritage Council, the Heritage Register and the heritage registration process
is available on the ACT Heritage website at www.environment.act.gov.au/heritage 
or by contacting ACT Heritage on 13 22 81 or by email at heritage@act.gov.au. 

LODGING YOUR FORM
Please send this form
o by mail to: The ACT Heritage Council, PO Box 158, Canberra  ACT 2601; 
o by hand to: ACT Heritage, Dame Pattie Menzies House, 16 Challis Street, Dickson ACT
o	 by email to: heritage@act.gov.au 

01 DETAILS OF PLACE OR OBJECT

Place 		Object 

Type: 		natural 		Aboriginal 	 historic		other/combined

Name of place/object:	_________________________________________________________

Other names if any:	_________________________________________________________

Location:	________________________________________________________________
Address							Suburb

_______________________________________________________________________________________________
Block/Section/District/Division (If multiple addresses or blocks and sections, list all)

_______________________________________________________________________________________________
Description of place’s boundary or objects components

For Aboriginal places, natural or rural locations: 
attach a sketch map, map references and/or GPS coordinates.

Exact locations of Aboriginal places are treated as restricted information and should not be divulged to other
parties. 

02 YOUR DETAILS

Name:		________________________________________________________________
Title		First Name			Surname

Organisation	________________________________________________________________
Organisation Name (if the organisation is the nominator)	Position

Postal Address:________________________________________________________________
Postal Address					State	Postcode

Telephone:	________________________________________________________________
Business Hours		After Hours		Mobile

		_______________________________________________________________________________
Email

Do you have any personal association with the place or object? 		yes 		no

If yes, how would describe yourself:

owner 		tenant 		neighbour

a person with traditional (Aboriginal) affiliation with the place or object

other _______________________________

03 CONSERVATION MANAGEMENT PLAN 
You must attach to this application a copy of the Conservation Management Plan that – 

	Sets out the conservation measures that will be adopted for the place or object;
Describes any conditions on future use of the place or object to conserve the place or object and/or its heritage significance;
	Identifies any threat, or potential threat, to the place or object and/or its heritage significance;
	Establishes a plan for management of any threats or potential threats;
Describes the place or object;
Provides an historical summary for the place or object; and
Provides details about the heritage significance of the place or object.

List all attachments enclosed:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

04. PERSONAL INFORMATION DISCLOSURE STATEMENT
The personal information on this form is provided to the ACT Heritage Council and ACT Environment and Planning Directorate (EPD) to enable the processing of your application. The collection of personal information is required by the Heritage Act 2004. The Heritage Act requires the details of the applicant’s name and address to be provided with an application for approval of a conservation management plan. If all or some of the personal information is not collected EPD and the Heritage Council cannot process your application. EPD’s Information Privacy Policy contains information about how you may access or seek to correct your personal information held by EPD, and how you may complain about an alleged breach of the Territory Privacy Principles. The EPD Information Privacy Policy can be found at www.act.gov.au/edp/information_privacy

05 AUTHORISATION 

I wish to make an application for the Heritage Council to approve the attached Conservation Management Plan (CMP).  

The information provided in the CMP is accurate to the best of my knowledge.

I understand that giving false or misleading information is a serious offence under the Criminal Code 2002.

Signed: ______________________________

Date: _________________