Operations Support Parks and Environment Department

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Office Use Only

Cashier Use

Operations Support Use

Receipt No:

Application: RC

Request No:

COST CENTRE: 9100101612

Allocation Reference: PLNTRE

Allocated To:

Operations Support
Parks and Environment Department
2016/17 Tree Assessment Form

This form is for the assessment of tree removal and/or pruning and exemption
from a permit under the Yarra Ranges Council Planning Scheme

Charge for Assessment (from 23/05/16)

1st Tree Inspected


Each additional tree

$87 each

(1 tree-$200, 2 trees-$287, 3 trees-$374, etc)

Applicant Name:

Postal Address:

Email (if applicable)



(After Hours or Mobile)

Address of Property for Tree Assessment:

Total number of trees to

be assessed on property:

Please mark trees to be inspected with coloured tape or cloth and draw a map below to enable easy identification on-site (Attach a separate map if there is not enough room below)

Applicants must answer the questions overleaf and sign on page 3
Why are the tree/s considered dangerous? (this section must be completed)

Is the tree dead? YES or NO (A permit is not required to remove completely dead trees.)

When did you notice the tree/s were dangerous?...............................................................................................

What sort of changes have you noticed?

Are the roots near roads / trenches / or recently been cut?

Describe the tree top / foliage

What would the tree hit if it were to fall?

Distance from existing building:

Species (if known):
Note that the following common weed species are exempt (see dot point 3 below): Pinus radiata, Acer pseudoplatanus, Acacia elata, Melaleuca armillaris, Fraxinus ornus and Salix species.

Exemptions to assessment and permit requirements

A permit is NOT required to remove, destroy or lop any vegetation if the vegetation is any of the following (clarification on any terminology contained here can be obtained from the Planning Department-1300 368 333):

  • On land in an Industrial 1 Zone.

  • Proclaimed as a noxious weed under the Catchment and Land Protection Act 1994.

  • Listed as an environmental weed in the local planning policy for Vegetation Protection (Clause 22.05).

  • Within 2 metres of any lawfully existing building or within 2 metres of any development that has been permitted under the planning scheme. If there are branches overhanging an existing building, they may be lopped so that they are not within 2 metres of the building.

  • Dead, or has been assessed as being dangerous by an authorised officer of the responsible authority.

  • Within 10 metres of an existing building used for accommodation that was either: constructed before 10 September 2009; or approved by a planning permit issued before 10 September 2009; or approved by a building permit issued under the Building Act 1993 before 10 September 2009.

  • For a combined maximum width of 4 metres either side of an existing fence on a boundary between properties in different ownership that was constructed before 10 September 2009.

PLEASE NOTE: The above exemptions may not apply if the property is subject to planning overlays (i.e. landslip, significant landscape, heritage, etc) or if there are specific legal agreements in place, such as 173 agreements. If you need information on this please call Council on 1300 368 333
Terms and conditions


Yarra Ranges Council represents and warrants to customer that the council will:

(i)use suitably qualified arborists to undertake the assessment;
(ii)exercise due skill, care and diligence in the carrying out and completion of the tree assessment activities;
(iii)conduct a visual tree assessment only of the tree under assessment;
(iv)execute and complete the tree assessment activities in accordance with accepted industry practice and fit for the intended purpose;
(v)to the fullest extent permitted by law exclude all statutory or implied warranties, other than the above warranties, in respect of the tree assessment activities undertaken by Yarra Ranges of it’s contractors.

Legal liability
To the fullest extent permitted by law, except for personal injury or death directly caused or to the extent contributed to by a negligent act or omission of Yarra Ranges Council, Yarra Ranges Council will not otherwise be liable to the Customer, whether in contract, tort (including negligence), under statute, in equity or on any other legal basis for any loss, damage (including economic and consequential loss or damage), injury, death, costs, charges or expenses resulting from or in any way connected with this service.

I hereby agree to the terms and conditions listed above and authorise Officers to enter onto my property at the above address for the purpose of assessing trees described on the plan referred to in this application.

Signature of Landowner: Date:

If you have any questions please call Yarra Ranges Council on 1300 368 333
Please return this form and the appropriate payment to Yarra Ranges Council in person at your closest Community Link, email the completed form to mail@yarraranges.vic.gov.au, or post to:
Operations Support

Yarra Ranges Council

PO Box 105

Lilydale VIC 3140

*Credit card request form – private tree assessment

Full Name on Card:

Credit Card Number:

Expiry Date:


Type of Card:

MasterCard □ Visa

Signature of Cardholder:

Receipt Number (to be completed by Cashier):

*This portion of the request form to be removed and processed by Cashiers. The remainder of the form is to be sent to Operations Support.

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