Minor Heritage Works Application

This form may be used to apply for a minor work application under Clause 5.10 (3) of the Queanbeyan Palerang Regional Local Environmental Plan 2022.

Section A - Details of the land where the work is to be carried out

Details of the land where the work is to be carried out *

Unit/Street number *Street name *

Locality/Suburb *

State *

Postcode *

Lot (if known)

Section (if known)

Deposited Plan (DP) (if known)

SECTION B - OWNERS DETAILS

Owner name(s) *

Owner signature (1)

Draw signature|Type signatureClear

Owner signature (2)

Draw signature|Type signatureClear

Section B - Details of the applicant/owner

Where the land is part of a Community Title or Strata Scheme then the Community Association/Body Corporate must also consent to lodging the application.
If the owner is an organisation/company the Authorised Officer and/or Director(s) must authorise the submission of the application and attach a signed letter on the organisation or company letterhead.

Is the applicant also the property owner? *

YesNo

Applicant name(s) *

Contact person *

Applicant address *

Unit/Street number *Street name *

Locality/Suburb *

State *

Postcode *

Phone *

Email Address *

Attach owner authorisation if applicant is not the owner

Browse

Corporate owner/Strata authorisation (if required)

Browse

Describe the minor works, e.g., proposed materials, colours and location of the works: NOTE: Any documentation, including plans for the proposal, can be attached to this application. For proposed painting works please detail names of proposed paint colours (e.g. Dulux Antique White USA, not ‘white’) and where they will be applied. Photographs to accompany your application are encouraged. *

Please attach photos and/or sketches of the proposal below *

Browse

Office Use Only – to be completed by assessing officer. Section C. Clause 5.10 (3) Assessment

What is the significance of the subject site?

Heritage ItemHeritage Conservation AreaNeighbour to a Heritage Item

Is the proposal of a minor nature or for the maintenance of the heritage item, Aboriginal object, Aboriginal place of heritage significance or archaeological site or a building, work, relic, tree or place within the heritage conservation area?

YesNo

Would the proposal adversely affect the heritage significance of the heritage item, Aboriginal object, Aboriginal place, archaeological site or heritage conservation area?

YesNo

Is the development in a cemetery or burial ground and for the creation of a new grave or monument, or excavation or disturbance of land for the purpose of conserving or repairing monuments or grave markers, and would not cause disturbance to human remains, relics, Aboriginal objects in the form of grave goods, or to an Aboriginal place of heritage significance?

YesNo

Is the development limited to the removal of a tree or other vegetation that the Council is satisfied is a risk to human life or property?

YesNo

Would the proposal be exempt development if it were not affected by heritage?

YesNo

Is a Development Application Required for works not associated with heritage?

YesNo

If the site is a listed State Heritage Item or within the State Heritage listed area of Braidwood, does the proposal meet the NSW State Heritage Exemptions?

YesNo

Has the assessment concluded that the proposal is minor works under this Clause?

YesNo

Notes and comments

Assessed by

Date