APPLICATION FOR LOCATIONAL CLEARANCE/CERTIFICATE OF ZONING COMPLIAN

Requirements:
Site Development Plan
Vicinity Map
Proof of Ownership
Tax Declaration/COT/OCT
Land Tax Receipt (current year)
Sketch Plan of the House
Brgy. Bldg. Clearance
Bill of Materials
Cedula (photocopy)
DPWH Clearance
Certificate of Fire Safety
ECC (if applicable)

Information Data for Locational Clearance

Date Filed

Name of Applicant
Address of Applicant
Name of Corporation (if applicable)
Address of Corporation
Contact No/s of Company/Office
Name of Authorized Representative
Address of Authorized Representative
Contact No.s
Project Type
Project Location
Estimated Project Cost

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Estimated Figure Amount

Land/Lot Area (in square meter)
Building Area (in square meter)
Community Tax Certificate No.
Place of Issue
Date of Issue

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Application No.
Decision No.
Date Issued of LC
Classification ( based in Zoning Ord.)
Existing Land Use/Project Type

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?
Evaluation of Facts
Decision
Date of Inspection
Inspected by
Paid O.R. No.
Total Amount Paid
Issued on

To be filled-up by the Zoning Officer

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AL CLEARANCE/CERTIFICATE OF ZONING COMPLIANCE

PROCEDURE
1. Fill out completely information form below.
2. Had your requirements verified by Zoning Officer.
3. Information data will be encoded and wait for the
schedule of site visit and evaluation report.
4. Secure Order of Payment.
5. Issuance of Locational/Zoning Clearance

mation Data for Locational Clearance

27-Dec-12
Ms. Lita C. Lumacad
Larapan, Jagna, Bohol

9481333666

09481333666
Residential
Larapan, Jagna, Bohol
Eight Hundred Fifty Two Thousand Three Hundred Twenty Pesos & 49/100

852,320.49
676
174
24110005
Larapan, Jagna, Bohol
11-Jan-12

Name Applicant/Authorized Representative & Signature

2012-27
J-019
27-Dec-12
Residential
Residential

be filled-up by the Zoning Officer

conforme to the approved CLUP and Zoning Ordinance
For Approval
Balbino Balaba
3622060
947.32
27-Dec-12

Republic of the Philippines

Province of Bohol
Municipality of Jagna

LOCATIONAL/ZONING CLEARANCE
Name of Owner
Address
Location of Project
Type of Use
Estimated Cost of Bldg

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:
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:

Ms. Lita C. Lumacad

Larapan, Jagna, Bohol
Larapan, Jagna, Bohol

Residential

852,320.49

PhP

ORDER OF PAYMENTS

Vicinity Map

Zoning/Locational Clearance
Land Use Verification
Issuance of Certificate of Zoning

Proof of Ownership

Application for Certificate of Zoning Compliance

Tax Declaration/COT/OCT

Certificate of Non-conformance
Grant of Exceptions or Variance
Land Development Fee
Appeal Fee

Requirements:
Site Development Plan

Land Tax Receipt (current year)

Sketch Plan of the House
Brgy. Bldg. Clearance
Bill of Materials
Cedula (photocopy)

Remarks/Findings:

DPWH Clearance
Certificate of Fire Safety

ECC (if applicable)

Checked by:
ENGR. GERRY V. ARANETA
Municipal Zoning Administrator

CLEARANCE
Application No.
Decision No.
Date Received
Date Issued
Floor Area(sq.m)

2012-27
J-019

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5-May-11
27-Dec-12
676.00

ORDER OF PAYMENTS

RY V. ARANETA
ing Administrator

872.32
5.00
45.00
25.00
TOTAL

947.32

Republic of the Philippines

P R O V I N C E OF B O H O L
Municipality of Jagna

OFFICE OF THE ZONING ADMINISTRATOR

APPLICATION FOR LOCATIONAL CLEARANCE/CERTIFICATE OF ZONING COMP

2012-27

Application No.
1. Name of Applicant

Date of Application :
2. Name of Corporation

Ms. Lita C. Lumacad

3. Address/Telephone of Applicant

0
4. Address/Telephone of Corporation

Larapan, Jagna, Bohol

5. Name of Authorized Representative

0
6. Address/Tel. of Authorized Representative

7. Project Type

8. Project Nature

Residential

9. Project Lo N.A.

Larapan, Jagna, Bohol

11. Right Over Land

( ) Owner
( ) Others (specify)
( ) Lease
________________
13. EXISTING LAND USE of the Project Site

(
(
(
10.

) New Development
) Improvement
) Others (specify) ________________
PROJECT AREA (in square meters)

Lot :
676
Building :
174
Improvement ____________
12. Project Tenure
( ) Permanent
( ) Temporary

( ) 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 & 49/100

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 OF
LOCATIONAL CLEARANCE/CLEARANCES OF ZONING COMPLIANCE (LZ/CZC)? ( ) Yes ( ) No

16. IS THE PROJECT APPLIED FOR THE SUBJECT OF SIMILAR APPLICATION(S) WITH OTHER OFFICE
THE BOARD AND/OR DEPUTIZED ZONING ADMINISTRATOR?
( ) Yes (Please indicate the following)
( ) No
Office where similar action(s) was filled ____________________________________
Date Filed 01-apr.-2011
Action Taken : Actual Site Inspected by
Balbino Balaba
17. PREFERRED MODE OR RELEASE OF DECISION:
( ) Pick-up
( ) By mail, addressed to:
18. SIGNATURE OF APPLICANT

Ms. Lita C. Lumacad

( ) Applicant
( ) Authorized Representative
19. SIGNATURE OF AUTHORIZED REP.

Republic of the Philippines) S.S.

Municipality of Jagna, Bohol
SUBSCRIBED AND SWORN TO before me this
day of
,20
Municipality of Jagna Province of Bohol. Affiant exhibited his/her Community Tax Certificate No.
issued at
Larapan, Jagna, Bohol
on
11-Jan-12

ATTY. FORTUNATO
Municipal May
Paid Under OR No.
Issued On:

3622060
1-Apr-11

Issued at
Jagna, Bohol
Amount Paid:
P

947.32

ZONING COMPLIANCE
27-Dec-12

tive

Crop)
_____

852,320.49

AND/OR
F

TH OTHER OFFICES OF

Balaba

d Representative

in the
24110005
.

Y. FORTUNATO R. ABRENILLA
Municipal Mayor

Republic of the Philippines

PROVINCE OF BOHOL
Municipality of Jagna
Jagna, Bohol

ZONING/LOCATIONAL CLEARANCE
Application No.

2012-27

Decision No.

J-019

Date of Receipt

27-Dec-12

Date Issued

27-Dec-12

Name of Applicant

Name of Corporation

Ms. Lita C. Lumacad

Address/Telephone of Applicant

0
Address/Telephone of Corporation

Larapan, Jagna, Bohol

Name/Type of Project

0
Project Location

Residential
Right Over Land

Larapan, Jagna, Bohol

Land Area ( sq.m)
676

Findings
conforme to the approved CLUP and Zoning Ordinance
Decision

For 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 o
existing laws shall be complied with.
[ ]
No activity other than that applied for and granted shall be conducted within th
project
siteexpansion, alteration and/or improvement shall be introduced without prio
[ ]
No
major
clearance
from
this not
Office.
[ ]
This
decision
shall
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 thi
decision shall be sufficient cause for its revocation.
[ ]
Additional conditions:
[ ]
Provisions as to setback, yard requirements, bulk, easement, area, heigh
and other restrictions shall strictly conform with the requirements of th
National Building Code of the Philippines and other related laws.
[ ]

This decision shall be considered automatically revoked if project is no

commenced within one (1) year from the date of issue of this decision.

ENGR. GERRY V. ARANETA

ZONING ADMINISTRATOR
Paid Under OR No.
Issued On:
Issued at Jagna . Bohol
Amount Paid:
P

3622060
27-Dec-12

27-Dec-12

NCE
J-019
27-Dec-12

on
0
of Corporation
0

pan, Jagna, Bohol

Building
174

rdinance

ubject to monitoring.
l action.
plicable provisions of

conducted within the

oduced without prior
hip over the parcel(s)
the issuance of this

sement, area, height

requirements of the
ed laws.

ked if project is not

f this decision.

RY V. ARANETA
DMINISTRATOR

PROJECT EVALUATION REPORT

A. APPLICANTS INFORMATION
Name of Applicant (Last, First, Middle)

Name of Corporation

Ms. Lita C. Lumacad

Address/Telephone of Applicant

Address/Telephone of Corporation

09481333666

948133366

B. PROJECT INFORMATION
Name/Type
Location
Area (sq. m.)
Area of Bldg.

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Residential
Larapan, Jagna, Bohol
676
174

Classification
Site Zoning
Classification
Right Over Land
Others

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C. SITE INSPECTION FINDINGS

Date of Inspection

30-Dec-99

Existing land uses within lot bounda

project site:
[ ] Proposed
[ ] Completed
[ ]Residential
[ ] Operational
[ ] % Completed
[ ] Commercial
[ ] Others (Specify)
[ ] Agricultural
In case of agricultural
Existing Land Uses Abutting Lot Boundaries of the Project:
Specify crops
Tenancy Status
North (a)
South (b)
[ ] Tenanted
East (c)
West (d)
Existing land uses
100m R
500m R
100m R
Residential
[ ]
[ ]
Industrial
[ ]
Commercial
[ ]
[ ]
Agricultural
[ ]
Institutional
[ ]
[ ]
Others
[ ]
(Pls. Specify)

D. SKETCH OF PROJECT LOCATION & SIGNIFICANT FINDIN

THIS SITE

EVALUATION REPORT

CANTS INFORMATION
Name of Corporation
0
Address/Telephone of Corporation
9481333666

JECT INFORMATION
Residential
Residential

SPECTION FINDINGS
Existing land uses within lot boundaries of
[
[
[
In

]Residential
] Commercial
] Agricultural
case of agricultural

[ ] Institutional
[ ] Industrial
[ ] Others

Tenancy Status
[ ] Tenanted

[ ]Not Tenanted
100m R
[ ]
[ ]
[ ]

500m R
[ ]
[ ]
[ ]

LOCATION & SIGNIFICANT FINDINGS

Annex D, Page 1

E. LEGAL BASES RECOMMENDED DECISION

Legal Bases:
[ ] CLUP/ZO approved by HLURB/SP per
Resolution No. _____ Series of ____ (date)
[ ] 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
requirements of other agencies and/or as provided for in local zoning ordinance.

G. SIGNATORIES
Prepared by:
VICENTE LL. ORIAS
Zoning Officer Designate
Print Name and Sign/Designation
____________________
Date

G. REPORT ATTACHMENTS
[ ] Location as inspected
[ ] Supplementary report

RECOMMENDED DECISION

Findings and Evaluation of Facts:

conforme to the approved CLUP and Zoning
Ordinance

ONAL CONDITIONS

ed, e.g. setback, building height, compliance to specific

ed for in local zoning ordinance.

SIGNATORIES
Noted by:
ENGR.GERRY V. ARANETA
Municipal Zoning Administrator
Print Name and Sign/Designation
____________________
Date

RT ATTACHMENTS
[ ] Others (Specify) _____________________

Annex D, Page 2