HERITAGE ACT 2004
					AF2017-3
For ACT Heritage Use Only	
Date received		
File No.		
Database ID		
Date to Council		
Decision date		
Accepted?		

APPLICATION FOR APPROVAL OF A CONSERVATION MANAGEMENT PLAN
Heritage Act 2004, s 61J and s 110

The 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 section 76 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;
•	Development approval under the Planning and Development Act 2007 chapter 7; 
•	An excavation permit;
•	A Statement of Heritage Effect approved by the Council; or
•	If the person is a government officer exercising a function for the Act or another Territory law or engaging in authorised conduct.

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

The Council’s CMP Guiding Principles is available at http://www.environment.act.gov.au/heritage/publications-and-resources

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. A fee is payable by a public authority seeking approval of a CMP. A schedule of fees is available on the ACT Heritage website at http://www.environment.act.gov.au/heritage/publications-and-resources/forms_and_fees      

The 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.

 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 

A request for urgent provisional registration will not be accepted unless signed and dated.

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 policies and management actions that will be adopted for the place 	or 	object;
	Describes any conditions on future use of the place or object to conserve the heritage 	significance of the place or object;
	Identifies any threat, or potential threat, to the heritage significance of the place or object;
	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 AUTHORISATION AND PERSONAL INFORMATION DISCLOSURE STATEMENT

I apply 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: _________________

The personal information on this form is provided to the ACT Heritage Council (the Council) the Environment, Planning and Sustainable Development Directorate (EPSDD) to enable the processing of your application. The collection of personal information is required by the Heritage Act 2004 (the Act). The 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 EPSDD and the Council cannot process your application. EPSDD’s Information Privacy Policy contains information about how you may access or seek to correct your personal information held by EPSDD, and how you may complain about an alleged breach of the Territory Privacy Principles. The EPSDD Information Privacy Policy can be found at http://www.environment.act.gov.au/about/privacy