DATA FORMAPPLICATION FOR LOCATIONAL CLEARANCE/CERTIFICATE OF
ZONING COMPLIANCERequirements: Site Development PlanPROCEDURE
Vicinity Map1. Fill out completely information form below. Proof of
Ownership2. Had your requirements verified by Zoning Officer. Tax
Declaration/COT/OCT3. Information data will be encoded and wait for
the Land Tax Receipt (current year) schedule of site visit and
evaluation report. Sketch Plan of the House4. Secure Order of
Payment. Brgy. Bldg. Clearance5. Issuance of Locational/Zoning
Clearance Bill of Materials Cedula (photocopy) DPWH Clearance
Certificate of Fire Safety ECC (if applicable)
? Information Data for Locational Clearance
Date Filed:27-Dec-12Name of Applicant:Ms. Lita C. LumacadAddress
of Applicant:Larapan, Jagna, BoholName of Corporation (if
applicable):Address of Corporation:Contact No/s of
Company/Office:9481333666Name of Authorized Representative:Address
of Authorized Representative:Contact No.s:09481333666Project
Type:ResidentialProject Location:Larapan, Jagna, BoholEstimated
Project Cost::Eight Hundred Fifty Two Thousand Three Hundred Twenty
Pesos & 49/100Estimated Figure Amount852,320.49Land/Lot Area
(in square meter):676Building Area (in square meter):174Community
Tax Certificate No.:24110005Place of Issue:Larapan, Jagna,
BoholDate of Issue:11-Jan-12
Name Applicant/Authorized Representative & Signature
Application No.:2012-27Decision No.:J-019Date Issued of
LC:27-Dec-12Classification ( based in Zoning
Ord.):ResidentialExisting Land Use/Project Type:Residential? To be
filled-up by the Zoning OfficerEvaluation of Facts :conforme to the
approved CLUP and Zoning OrdinanceDecision:For ApprovalDate of
Inspection:Inspected by:Balbino BalabaPaid O.R. No.:3622060Total
Amount Paid:947.32Issued on:27-Dec-12
OP-Residential
Republic of the PhilippinesProvince of BoholMunicipality of
Jagna
LOCATIONAL/ZONING CLEARANCE
Name of Owner:Ms. Lita C. LumacadApplication
No.:2012-27Address:Larapan, Jagna, BoholDecision No.J-019Location
of Project:Larapan, Jagna, BoholDate Received:5-May-11Type of
Use:ResidentialDate Issued:27-Dec-12Estimated Cost of
Bldg:PhP852,320.49Floor Area(sq.m):676.00
ORDER OF PAYMENTSRequirements:Zoning/Locational
Clearance872.32Site Development PlanLand Use
Verification5.00Vicinity MapIssuance of Certificate of
Zoning45.00Proof of OwnershipApplication for Certificate of Zoning
Compliance25.00Tax Declaration/COT/OCTCertificate of
Non-conformance-Land Tax Receipt (current year)Grant of Exceptions
or Variance-Sketch Plan of the HouseLand Development Fee-Brgy.
Bldg. ClearanceAppeal Fee-Bill of MaterialsTOTAL947.32Cedula
(photocopy)Remarks/Findings:DPWH ClearanceCertificate of Fire
SafetyECC (if applicable)
Checked by:ENGR. GERRY V. ARANETAMunicipal Zoning
Administrator
Application for Locational
Republic of the PhilippinesP R O V I N C E OF B O H O
LMunicipality of Jagna
OFFICE OF THE ZONING ADMINISTRATOR
APPLICATION FOR LOCATIONAL CLEARANCE/CERTIFICATE OF ZONING
COMPLIANCE
Application No. 2012-27Date of Application:27-Dec-12
1. Name of Applicant2. Name of CorporationMs. Lita C. Lumacad03.
Address/Telephone of Applicant4. Address/Telephone of
CorporationLarapan, Jagna, Bohol05. Name of Authorized
Representative6. Address/Tel. of Authorized Representative007.
Project Type8. Project Nature Residential ( ) New Development ( )
Improvement ( ) Others (specify) ________________9. Project
LocationN.A.10. PROJECT AREA (in square meters)Larapan, Jagna,
Bohol Lot :676 Building :174 Improvement ____________11. Right Over
Land12. Project Tenure ( ) Owner ( ) Others (specify) ( ) Permanent
( ) Lease ________________ ( ) Temporary13. EXISTING LAND USE of
the Project Site( ) Residential ( ) Commercial ( ) Others ( )
Vacant/Idle ( ) Agricultural (Specify Crop)( ) Institutional ( )
Industrial ( ) Tenanted ( ) Not Tenanted
_________________________14. PROJECT COST (in pesos, write in words
and figures) Eight Hundred Fifty Two Thousand Three Hundred Twenty
Pesos & 49/100P852,320.49
15. IS THE PROJECT APPLIED FOR THE SUBJECT OF WRITTEN NOTICE(S)
FROM THIS BOARD AND/OR DEPUTIZED ZONING ADMINISTRATOR TO THE EFFECT
REQUIRING FOR REPRESENTATION OFLOCATIONAL CLEARANCE/CLEARANCES OF
ZONING COMPLIANCE (LZ/CZC)? ( ) Yes ( ) No
16. IS THE PROJECT APPLIED FOR THE SUBJECT OF SIMILAR
APPLICATION(S) WITH OTHER OFFICES OF THE BOARD AND/OR DEPUTIZED
ZONING ADMINISTRATOR? ( ) Yes (Please indicate the following) ( )
No Office where similar action(s) was filled
____________________________________Date Filed 01-apr.-2011Action
Taken : Actual Site Inspected byBalbino Balaba
17. PREFERRED MODE OR RELEASE OF DECISION: ( ) Pick-up ( ) By
mail, addressed to: ( ) Applicant ( ) Authorized Representative18.
SIGNATURE OF APPLICANT19. SIGNATURE OF AUTHORIZED REP.Ms. Lita C.
Lumacad0
Republic of the Philippines) S.S.Municipality of Jagna,
Bohol
SUBSCRIBED AND SWORN TO before me thisday of,20 in
theMunicipality of Jagna Province of Bohol. Affiant exhibited
his/her Community Tax Certificate No.24110005issued atLarapan,
Jagna, Boholon11-Jan-12.
ATTY. FORTUNATO R. ABRENILLA Municipal Mayor
Paid Under OR No.3622060Issued On:1-Apr-11Issued at Jagna,
BoholAmount Paid: P 947.32
Locational ClearanceRepublic of the PhilippinesPROVINCE OF
BOHOLMunicipality of JagnaJagna, Bohol
ZONING/LOCATIONAL CLEARANCE
Application No.2012-27Decision No.Decision No.J-019
Date of Receipt27-Dec-12Date IssuedDate Issued27-Dec-12
Name of ApplicantName of CorporationMs. Lita C. Lumacad0
Address/Telephone of ApplicantAddress/Telephone of
CorporationLarapan, Jagna, Bohol0
Name/Type of ProjectProject LocationResidentialLarapan, Jagna,
Bohol
Right Over LandLand Area ( sq.m)Building676174
Findingsconforme to the approved CLUP and Zoning Ordinance
DecisionFor Approval
CONDITIONS:[ ]All conditions stipulated herein form part of this
decision and are subject to monitoring.[ ]Non compliance therewith
shall be a cause for cancellation or legal action.[ ]The applicable
requirements of government agencies and applicable provisions of
existing laws shall be complied with.[ ]No activity other than that
applied for and granted shall be conducted within the project site[
]No major expansion, alteration and/or improvement shall be
introduced without prior clearance from this Office.[ ]This
decision shall not be construed as a Certification of Ownership
over the parcel(s) of land subject of this decision.[ ]Any
misrepresentation, false statement or allegation material to the
issuance of this decision shall be sufficient cause for its
revocation.[ ]Additional conditions:[ ]Provisions as to setback,
yard requirements, bulk, easement, area, height and other
restrictions shall strictly conform with the requirements of the
National Building Code of the Philippines and other related laws.[
]This decision shall be considered automatically revoked if project
is not commenced within one (1) year from the date of issue of this
decision.
ENGR. GERRY V. ARANETAZONING ADMINISTRATOR
Paid Under OR No.3622060Issued On:27-Dec-12Issued at Jagna .
BoholAmount Paid: P 27-Dec-12
Evaluation Report 1PROJECT EVALUATION REPORT
A. APPLICANTS INFORMATION
Name of Applicant (Last, First, Middle)Name of CorporationMs.
Lita C. Lumacad0
Address/Telephone of ApplicantAddress/Telephone of
Corporation094813336669481333666
B. PROJECT INFORMATION
Name/Type:ResidentialClassification:ResidentialLocation:Larapan,
Jagna, BoholSite Zoning Classification:ResidentialArea (sq.
m.):676Right Over Land:Area of Bldg.:174Others:
C. SITE INSPECTION FINDINGS
Date of Inspection 31-Dec-99Existing land uses within lot
boundaries of project site:[ ] Proposed[ ] Completed[ ]Residential
[ ] Institutional[ ] Operational[ ] % Completed[ ] Commercial[ ]
Industrial[ ] Others (Specify)[ ] Agricultural[ ] OthersIn case of
agriculturalExisting Land Uses Abutting Lot Boundaries of the
Project: Specify crops Tenancy StatusNorth (a)South (b) [ ]
Tenanted[ ]Not TenantedEast (c) West (d) Existing land uses100m
R500m R100m R500m RResidential[ ][ ]Industrial[ ][ ]Commercial[ ][
]Agricultural[ ][ ]Institutional[ ][ ]Others [ ][ ](Pls.
Specify)
D. SKETCH OF PROJECT LOCATION & SIGNIFICANT FINDINGS
Annex D, Page 1
THIS SITE
Evaluation Report 2
E. LEGAL BASES RECOMMENDED DECISION
Legal Bases:
[ ] CLUP/ZO approved by HLURB/SP per Findings and Evaluation of
Facts: Resolution No. _____ Series of ____ (date)conforme to the
approved CLUP and Zoning Ordinance[ ] Others (Specify law,
Implementing Rules and Regulations or Guidelines) _________
______________________________________
Recommended Decision
F. ADDITIONAL CONDITIONS
As may be necessary, restrictions may be imposed, e.g. setback,
building height, compliance to specific requirements of other
agencies and/or as provided for in local zoning ordinance.
G. SIGNATORIES
Prepared by:Noted by:
VICENTE LL. ORIASENGR.GERRY V. ARANETAZoning Officer
DesignateMunicipal Zoning AdministratorPrint Name and
Sign/DesignationPrint Name and
Sign/Designation________________________________________DateDate
G. REPORT ATTACHMENTS
[ ] Location as inspected[ ] Others (Specify)
_____________________[ ] Supplementary report
Annex D, Page 2