NBC FORM No. A-05
Republic ofthe Philippines
Municipality of General Luna
Province of Surigao del Norte
OFFICE OF THE BUILDING OFFICIAL.
SANITARY PERMIT
[APPLICATION No, SP No. BUILDING PERMIT No,
BOX 1 (10 BE ACCOMPLISHED IN PRINT BY THE OWNERIAPPLICANT)
[OWNER APPLICANT: DST IE FRET RTE TOE NAE rw
[FOR CONSTRUCTION OWNED BY AN ENTERPRISE ESR OF ORES JOSE OR CARRCTER OF SOSTPRRET
[ADDRRESS: No REET RY ST RNSPRTY APOE TELEPHONE RT
[COcATION OF CONSTRUCTION:
srecer_ sasancny GENERAL LUNA, SURIGNO DEL NORTE
[SCOPE OF WoRK
[D NEW consTRUCTION | RENOVATION CO RasINe
| ERECTION CONVERSION |L ACCESSORY BULOINGISTRUCTURE
ADDITION REPAR [1 OTHERS (Specty
ALTERATION EL MOVING:
‘BOX. (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
[INSTALLATION AND OPERATIONS OF:
WATER SUPPLY ‘SYSTEM OF DISPOSAL:
SHALLOW WELL WASTE WATER TREATMENT PLANT 1D SURFACE ORANAGE
DEEP WELL AND PUMP SET IMHOFF TANKISEPTIC TANK [1 STREET CANAL
MUNICIPAL WATER SYSTEM 1D SANITARY SEWER CONNECTION WATER couRse
OTHERS (Spectyy _ SSUB-SURFACES ANO FILTER [J OTHERS (Speci
Box
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[DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS
[SUPERVISOR /IN-CHARGE OF PLUMBING WORKS
‘SANITARY ENGINEER ‘SANITARY ENGINEER
(St, are Seated over Pots Nae) (Ses a Seal oer rte Nae)
ae = te
[acres Pree
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[BUILDING OWNER |WiTH iv CONSENT: LOT OWNER
Sara oa PTNSTAT Sa a PTT‘TO BE ACCOMPLISHE BY THE PROCESSING AND EVALUATION DIVISION
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RECENED BY: PATE
FOUR (4) SETS OF SANITARY DOCUMENTS:
[1 SANITARY PLANS AND SPECIFICATIONS OTHERS (Spee)
SILL OF MATERIALS
BOxs.
PROGRESS FLOW
PROCESSED BY:
Tine DATE
RECEIVING AND RECORDING
[sawrraRy
[OTHERS (Speciy
Boxe
ACTION TAKEN:
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That the proposed sanitary works shall be in accordance with the sanitary plans fled with this Office and in
conformity with the latest Code on Sanitation of the Philippines, the National Building Code and its IRR.
2. That prior to any construction activity, a duly accomplished prescribed "NOTICE OF CONSTRUCTION" shall be
submitted to the Office of the Building Official.
3. That upon completion of the sanitary works, the licensed full-time inspector and supervisorlin-charge of construction
‘works shall submit the entry to the logbook duly signed and sealed to the Building Official including As-Built plans
and other documents, and shall also accomplish the Certificate of Completion stating that the sanitary works conform
to the provisions of the Code on Sanitation of the Philippines, the National Building Code and its IRR.
4 That this permit is null and void unless accompanied by the Bullding Permit.
PERMIT ISSUED BY:
ENGI
ERSON E, GALVEZ
BUILDING OFFICIAL
(Sionature over Printed Nara)
Date
NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 205 AND 206 OF THE ‘NATIONAL BUILONG CODE”.