Port Authority of New South Wales

This form is to be completed for all activities that are captured by Section 110 of the Ports and Maritime Administration Regulation 2021 (Regulation). Section 110 of the Regulation (Disturbance of bed of port) states:

"A person must not use drags, grapplings or other apparatus for lifting an object or material from the bed, or otherwise disturb the bed, of a port specified in Schedule 4 except— (a) with the written permission of the relevant harbour master, and (b) in accordance with the conditions of the permission."

Details of Applicant

Company / organisation / agency *

ABN *

First name *

Last name *

Position *

Postal address *

Suburb/town *

State *

Postcode *

Telephone *

Email *

Details of contact person for the Disturbance Activity (if different to Section 1)

Company / organisation / agency

ABN

First name

Last name

Position

Postal address

Suburb/town

State

Postcode

Telephone

Email

Details of Disturbance Activities

The Site is located within which port: * (as per Schedule 4 of the Ports and Maritime Administration Regulation 2021)

Yamba Newcastle Harbour Sydney Harbour Botany Bay Port Kembla Eden

Is this disturbance within Naval Waters? *

Yes
No

Manner in which the seabed is to be disturbed: *

Submarine cable Mooring blocks Barge spuds Dredging/Excavation/Sweeping Piling Borehole/Sampling Other

If other, please describe the manner of activity:

Nautical coordinates in WGS84 of the exact location of the proposed disturbance activity: * Note: A nautical chart may be attached at the end of this form, showing the location and extent of disturbance activity (including if possible, Computer-Aided Design (CAD) information)

Brief description of the disturbance (including methodologies): *

Anticipated impact to safety, security and efficiency of navigation and maritime operations in the vicinity, and proposed mitigation measures: *

Has the Applicant obtained Landowner’s consent for this disturbance activity? * Note: Landowner’s consent is required under relevant legislation for works affecting the seabed and evidence of such may be requested by Port Authority.

Yes
No

Owner of the seabed where the disturbance activity will occur: *

Desired commencement date of disturbance activity: *

Expected completion date of disturbance activity: *

Proposed timing of disturbance activity (e.g. daytime, night time): *

Has Transport for New South Wales Maritime been consulted for this disturbance activity? *

Yes
No

Summary of stakeholder consultation conducted: *

Please attach any relevant information to support the Harbour Master in assessing the proposal here:

Applicant's lodgement

By submitting this form, I agree for my personal information to be (i) collected for the purpose of handling my application, and (ii) handled in accordance with Port Authority’s Privacy Statement.