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LLDA Clearance Application Form

This document is an application form for clearance from the Laguna Lake Development Authority (LLDA) for any development plans, programs, or projects in the Laguna de Bay region. It requests information about the applicant, the proposed project or business activity, water supply and wastewater details, and certification of the information provided. It informs that all information will be kept confidential by the LLDA.

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Mykka Artillaga
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2K views2 pages

LLDA Clearance Application Form

This document is an application form for clearance from the Laguna Lake Development Authority (LLDA) for any development plans, programs, or projects in the Laguna de Bay region. It requests information about the applicant, the proposed project or business activity, water supply and wastewater details, and certification of the information provided. It informs that all information will be kept confidential by the LLDA.

Uploaded by

Mykka Artillaga
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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LAGUNA LAKE DEVELOPMENT AUTHORITY

National Ecology Center, East Avenue


Diliman, Quezon City
Tel. Nos.: 332-2346, 376-4039, 376-4072, 376-4049, 376-4061

CLEARANCE APPLICATION FOR DEVELOPMENT PLAN/PROGRAM/PROJECT IN


THE LAGUNA de BAY REGION

LLDA CLEARANCE AMENDMENT EXEMPTION EXPANSION

PART I – APPLICANT INFORMATION

Name of Establishment: _______________________________________________________


Tax Identification Number (TIN): __________________________ Year Established: ___________

Business Address:
Number and Street: _______________________________ Barangay: ______________________
City/Municipality: _________________________________ Province: _______________________
GPS Coordinates: (Latitude) ________________________ (Longtitude) _____________________

Name & Location of Project/Development:


Project Name (if any): ____________________________________________________________
Number and Street: _______________________________ Barangay: ______________________
City/Municipality: _________________________________ Province: _______________________

Chief Executive Officer of the Establishment:


Name: ___________________________________ Title/Designation: ______________________
Tel #: ____________ Fax #: _____________ Cel #: _____________ email add: ______________

Applicant’s Authorized Representative/Pollution Control Officer:


Name: ____________________________________Title/Designation: ______________________
Name of Firm: __________________________________________________________________
Number and Street: _______________________________ Barangay: ______________________
City/Municipality: ________________ Province: _______________Tel. # :___________________
Fax #: _________________ Cel. #: ________________ email add: ________________________

PART II – BUSINESS ACTIVITY DESCRIPTION

I. Business Activity: _______________________________


Production Capacity (allowed per ECC): ________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(continuation at the back)

LLDA-CPD-Form 01 Issue Date: November 2015 Issue No.: 02


A. Industrial Establishment/Infrastructure Projects and other similar project
Capital Investment (Authorized Capital Stock): PhP________________________
Total Project Cost: _____________________________
B. Agro-Industrial Establishment
Capacity (Maximum No. of Heads): ___________________________________________

C. Housing Development, Institution, Hospital, Commercial Establishments, Parks,


Golf Course warehouse/storage facilities, etc.
Gross Floor Area (sq.m): __________________ Total Lot Area (sq.m): ________________
For Townhouses/Villas/other cluster housing units (total no. of units): _________________

D. Other Projects (Land Transport Terminal/Parking Areas)


No. of vehicle slots: ___________________

II. Employment and Operation Information


Total Employment (number of workers) Operational Schedule/Time
Production: ________________ No. of hours/day: _________ shifts/day: _____
Non-Production: ____________ No. of days/month: _______________

PART III – WATER SUPPLY, WASTEWATER GENERATION, TREATMENT AND DISPOSAL


Sources of Water Supply
MWSI/MWCI ( ) Local Water District ( ) Deepwell ( ) Laguna de Bay ( )
Rivers ( ) Others ( )
Total Water Consumption (m3/day): ____________________
Wastewater Generation, Treatment and Disposal
Total Volume of Wastewater Discharge (m3/day): ___________________
Method of Treatment: _________________________________________
Disposal: ____________________________________________________

I certify that the information above are true, complete and accurate to the best of my knowledge.

_________________________________________ _______________________________
Signature of Representative/Pollution Control Officer Signature of Chief Executive Officer
Date: _________________________ Date: ________________________________

SUBSCRIBED AND SWORN to before me a NOTARY PUBLIC, this ______ day of


________________, affiant exhibiting to me his/her Community Tax Receipt No. _________________ issued
at ________________ on ___________________

NOTARY PUBLIC
Doc. No. ________
Page No. ________
Book No. ________
Series No. ________

All information contained in this application form will be held strictly confidential.

LLDA-CPD-Form 01 Issue Date: November 2015 Issue No.: 02

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