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