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Sanitary Permit (Front)

The document is a Sanitary Permit application form from the Clark Development Corporation in the Philippines. It requires information from the owner/applicant regarding construction details, ownership, and the scope of work, as well as sections for design professionals and supervisors to fill out. The form includes spaces for signatures, addresses, and relevant identification numbers.

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35 views1 page

Sanitary Permit (Front)

The document is a Sanitary Permit application form from the Clark Development Corporation in the Philippines. It requires information from the owner/applicant regarding construction details, ownership, and the scope of work, as well as sections for design professionals and supervisors to fill out. The form includes spaces for signatures, addresses, and relevant identification numbers.

Uploaded by

honeyletlett
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NBC FORM NO.

A- 05

Republic of the Philippines


CLARK DEVELOPMENT CORPORATION
Clark Freeport Zone and Clark Special Economic Zone

OFFICE OF THE BUILDING OFFICIAL

SANITARY PERMIT
APPLICATION NO. SP NO BUILDING PERMIT NO.

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)


OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY


BY AN ENTERPRISE
ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TELEPHONE NO

LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. _________________ TCT NO. _____________________ TAX DEC. NO. ____________________
STREET___________________ BARANGAY _________________________________________ CITY/ MUNICIPALITY OF ___________________________________________

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ________________________ RAISING________________________________________
ERECTION CONVERSION ________________________ DEMOLITION ____________________________________
ADDITION REPAIR _____________________________ ACCESSORY BUILDING/STRUCTURE________________
ALTERATION MOVING _____________________________ OTHERS (Specify)_________________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

INSTALLATION AND OPERATION OF:

WATER SUPPLY: SYSTEM OF DISPOSAL:

SHALLOW WELL WASTE WATER TREATMENT PLANT SURFACE DRAINAGE

DEEP WELL & PUMP SET IMHOFF TANK STREET CANAL

CITY/MUNICIPAL WATER SYSTEM SANITARY SEWER CONNECTION WATER COURSE

OTHERS (Specify) ______________ SUB-SURFACE SAND FILTER OTHERS (Specify) ________________

PREPARED BY: ______________________________________________________________________________________________________________________________

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF SANITARY WORKS

Date_____________ Date_____________
SANITARY ENGINEER SANITARY ENGINEER
(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)
Address Address
PRC. No Validity PRC. No Validity
PTR. No Date Issued PTR. No Date Issued
Issued at TIN Issued at TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

(Signature Over Printed Name) (Signature Over Printed Name)


Date_________________ Date_________________
Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued

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