Application form
Heritage
Permit to enter a Protected Area
Use this form to apply for a permit to enter a Protected Area under the Queensland Heritage Act 1992.
1.
Applicant details
APPLICANT NAME
TITLE
ORGANISATION (IF APPLICABLE)
ADDRESS
TELEPHONE
FACSIMILE
MOBILE PHONE
EMAIL
2.
Protected Area details
NAME OF PROTECTED AREA (AS LISTED IN THE QUEENSLAND HERITAGE REGISTER)
1.
QUEENSLAND HERITAGE REGISTER NUMBER
3.
Purpose of entering Protected Area
EXPLANATION OF THE PURPOSE OF ENTERING THE PROTECTED AREA
Application form
4.
Details of operations to be carried out in Protected Area
4.1
Description of operations
For complex projects prepare a separate detailed description and attach to this application.
DESCRIPTION OF OPERATION/S
Describe in full:
 The type of operations to be carried out
 Details of methods to be used
 How these will fulfil the purpose of the entering the area
 What impact the proposed works will have on the heritage values of the protected area .
4.2
Location of operation area/s
STREET ADDRESS (IF APPLICABLE)
GPS COORDINATE FOR MIDPOINT OF OPERATION AREA/S
GPS COORDINATES DEFINING THE OPERATION AREA/S BOUNDARY
SIZE OF OPERATION AREA /S (IN SQUARE METERS)
LOT ON PLAN AFFECTED
MINING LEASE AFFECTED (IF APPLICABLE)
Tick below if you are able to attach either of the following to this application to assist locating the
operation area:
GIS layer (geographic projection) and metadata (Format: ArcView / ArchInfo or MapInfo Export (mif))
Map, with scale and north arrow, showing location of operation area, and GPS co-ordinates
5.
Entry dates and duration of operations
EXPECTED ENTRY DATE/S
DURATION OFOPERATION/S
Page 2 of 4 • 151104
Department of Environment and Heritage Protection
www.ehp.qld.gov.au ABN 46 640 294 485
Application form
6.
Details of persons entering Protected Area
NAME
7.
CONTACT DETAILS
QUALIFICATIONS AND EXPERIENCE
Details of storage and conservation of recovered objects (if applicable)
DETAILS OF STORAGE AND CONSERVATION ARRANGEMENTS

Describe arrangements for the storage and conservation if objects are recovered during operations and who
is responsible for their ongoing protection?

It is a requirement to consult with the Queensland Museum regarding possible accessioning of
recovered objects prior to submitting this form. Tick below to confirm the following is attached:
Copy of correspondence with Queensland Museum regarding storage and conservation of objects (for
example, email or letter)
8.
Landowner permission
NAME OF LANDOWNER AND OCCUPIER (IF THE OCCUPIER IS NOT THE OWNER)
Note: Where the approval area is state land and is occupied by Aboriginal people, the consent of those people is
required (N.B. If there has been a determination of native title over the area, the consent of the native title body
corporate is required).
ADDRESS OF LANDOWNER AND OCCUPIER, INCLUDING ABORIGINAL PEOPLE AND NATIVE TITLE BODY CORPORATE, IF
APPLICABLE
Tick to confirm:
Copies of written permission for all relevant landowners/occupiers (including Aboriginal people and native title
bodies corporate if applicable) are attached to this application?
YES
Page 3 of 4 • 151104
NO
Department of Environment and Heritage Protection
www.ehp.qld.gov.au ABN 46 640 294 485
Application form
9.
Declaration
I do solemnly and sincerely declare that the information provided is true and correct to the best of my knowledge
and I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions
of the Oaths Act 1867.
I understand that all information supplied on or with this application form may be disclosed publicly in
accordance with the Right to Information Act 2009 and the Evidence Act 1977.
APPLICANT’S NAME
APPLICANT’S SIGNATURE
10.
DATE
Lodgement and fees
 A fee applies for an application to enter a Protected Area. Search fees and services at
www.ehp.qld.gov.au/ for fee information.
 Correct payment must accompany this application form.
 A request for further information may be made by the department if information supplied is insufficient.
 Applications are normally processed within 20 business days of lodgement. Complex or incomplete
applications may take longer.
Send one copy of the completed form, attachments and payment to:
Email:
PaLM@ehp.qld.gov.au
OR
Post:
Permit and Licence Management
Department of Environment and Heritage Protection
GPO Box2454
Brisbane Q 4001
Further information
 call 13 QGOV (13 74 68) and ask to speak to a Heritage Branch Officer
 email archaeology@ehp.qld.gov.au
 visit www.qld.gov.au/environment/land/heritage/
Office Use Only
DETAILS OF STAFF MEMBER ACCEPTING
REQUEST – PRINT NAME AND EXTENSION
PLEASE.
RECEIPT NUMBER:
Page 4 of 4 • 151104
______________
NAME: _____________________________________________
EXTENSION: ________________________________________
DATE:
______________
AMOUNT $:
_____________
Department of Environment and Heritage Protection
www.ehp.qld.gov.au ABN 46 640 294 485