Republic of the phitip-pines

WATER PERMIT
NATIONAL WATER RESOURCES
8th Floor, NtA Buitding, EDSA, Ditiman,
BOARD APPLICATION No
Orezon CitV Filec
Date

Fitins&t-eg@to
National Water Resources Board
Phil. Postal Money Order Nos

NWRB Officiat Receipt No.

2a. Tetepnone Ml
Date
3. TaxAccount tJo
6. Name of Water
Location or DivGEioffii 8. Method of Diversbn
9. Months of tow+tow
lo.WaterNeffi 11. Purpose
12. tf for AOricuttu[7fiffi;
for Domestic
erved i

14. tffortnoustry@ 15. tf for power, naGO

will be Used CapFlt!- 16. Other Uses
in Kilowatts r

Name of Pe ;
Downstream and Upstream or proposleb
e,"i.t;ioir"[i"i
V/ate r i n ct u ct i ng tn en rn o fri.a n-Elrr-aiFG
i.", {

I hereby cer-ti,y tnar: tf,e irEEZEi@GE6G- ancl sworn to before me on tnis

and tn documents submitted aieitrue and,cirrrect o5re---l
to the best o!,n:f,t no*,t"qgb anC,ttetief l-'
.,,, ,, .,.,, lr ,i
I \ i

BE FILLED BYNMIR-6 AGENT Public/Admin Officer

e.
-Locat;cn@
inr{inalin^ +h^
indicating the t^,,^,
layout.r of - -- --
^r proposed
t.
_ Certification works
I

l__J of lncorporation rf appticant is

_ an association or corporation
g. fl Otner information as specified under Sect. 4
Rules and Regulations implementing the
19, Diversion point Water Code
20. Possible a
Latitude:
Longitude :

-
a. 80% of time equatteO oEGGd b. Mean or montruy-orEEZffi c. Amount of Water recommenCE

22.othercommeffi
Prepared by:
Date:
I

Name and Abdress of NWRB Agent

NOTICE OF WATER PERMIT
APPLICATTON

No.

it to *i
tnis omc].h

bv the proposed appropriarion mav nre with

1*[xl3iffJ,[l?J:ljj,!fliXjJ]!:f:f* this ornce, a written and

3. Name of wateisouE
 INSTRUCTION FOR WATER PERMIT APPLICATIONS
A. No person shall di\ert tr appropriate water from any public wder source such as ri\ers, creeks, brooks, springs
lakes, lagoons, swtnps, marshes, subtenanean, or groundu/ater and sea water, without first securing a Water
Permit from the Natimal Water resources Board.

B. Water Permit Applicatims must be filed Wth the Office of the DPWH District Engineer, the NIA Provincial
lnigation Enginer, NPC Regifial Manager or the LWUA Water Districl Geneml Manager whiche\Er is
designded as agent by the Board in the pro/ince where the pcint of diversion is situated.

1. The folloiving may file an applicatim for Water Permit:

A. Citizens of the Philippines;
B. Association, duly registered cooperati\es or corporations organized under the
lanc of the Philippines at least 60 percent of lhe capital of wfiich is omed by the
citizens of the Philippines

C. Governrnent entities and instrumentalities, including go\ gmnEnt omed or controlled corporations.
2. All communications to the applicant, induding the Water Permit, will be directed to the mailing
address indicated. The National Water Resources Board must be nctified imrnediately of any
changes in address.

3. Applicants without a TIN must first secure one from the Bureau of lnternal Rewnue before filing
a Water Permit Application.
4. Only citizens of the Philippines of legal age, m well as judicial persons, who are qualified by
lar to explcit and danelop water resources, may apply for a Water Permit.

5. The PMMO or NWRB Official Receipt Number, the date and amornt paid shall be indicated.

6. The official name or (local narne) of the river, creek, brook, lake, etc., or the vvords spring
or groundwater, whichs/er is appropriate, shall be indicated.

7. The locatim of the diversion point indicating the sitic/Baffio and the municipality lvhere the
di\ersion point is located.

8. lndicate method of diverting water whether by dam, pump, etc.

9. lndicate tfle months during the )iear when the floe of the stream is considered low flotv
(say, for example, from January to ApriD.

10. lndicate the amount of water applied for, oeressed in liters per second.

1 1. The purpose of which a Water Permit is applied for whdher for Domestic, Municipal, lrrigdion,
Pover Generation, Fisheries, Li\estock Raising, lnduskial, Recreational or other purpose.
'12. lf water will be used for inigation, indicate the area of land in hectares and the crop to be raised.

13. For domestic water supply, indicate the number of people served.

14. Fq industry, such as mining, or other industrial purpose, make a brief description of the proposed
project including, among others, ho / the water will be used, the amount of water needed for the
purpce, the amount and quality of water to be discharged back to the source if any, and the
propced waste water treatment works to be prwided.

15. For hydraulic poler development, indicate the porrer plant rated capacity in kilowatts.
16. Specify other uses or which Water Permit is applied for.

17. lnclicate the names of appropridors holding or claiming rights to the used of water including the
amount in liters per second and nature of use, both dotvnstream and upstream of the proposed
pcint of di\Ersion.

C. Application with incomplete information and/or insufficient documentation shall not be accepted for filing

18-20. To be filled by NWRB Agent ;

21-22. ro befilled by NWRB Staff

D. Accomplished applicatim form must be in 4 copies and Notice of WPA must be in 10 copies
 IN FILING WATER
lished Water Permit
Land ownership (any ot *e @ Tax Declaration; Deed of Sale:
Lease Agreement; Deed of Donation; Certification from LGU to utilize
the source) 2
C. List of b"nefi"ia
M unicipal/Provincial Assessor
D. Location ptan and vicinity mEpGnowNfr
1. point of diversion of source of water
2. delineation of service area indicating hectarage for which water wiil
be used
3. nature of diversion works whether temporary or permanent
4. in case of location and sites
E. C O R P O RAT'OA'IPA R IA'E
and Certificate of latest Corporate Financial Structure issued by the
Corporate Secretary;
cooPERATlvE - certificate of Registration from cDA; s/IVG Le paopnteroR -
certificate
of Registration from DTI; WATER DISTR(CT, Certificate of Conformance
from LWUA
BARA N GAY WATERWORKS ASSO CtATtO N - Certifi cate of
. Compliance
Envirolr,nental
. Bacteriological Test 1if fou

from B. F.R. O
!-'1._9learance
l, from t-.t.O
9le.argrlce
J. Subdivision Plan
K. Brief description of project whicfr incJudes :
1. how water will be used
2. amount ofwater needed
3. power expected to be generated
4. amount of water to be discharged back to the source
5. measures to be taken to avoid water pollution
6. population and area to be served
7 . area of water surface needed for the purpose

Welldrilling data (Pumping Test,

gTOUNdWAtET SOUTCE. NOTE: WELL DRILLER MUST HAVE A VALID NWRB
cERTIFICATE oF REGISTRATIoN
M. Other requirement as deemed nece.saf Oy treEGE
REQUIRED DOCUMENTS TO Bffi
MUNICIPAL USE:'documents listed on letters A, B, D1, D3, D4, E, G, J, L, M
IRRIGATION/AGRICULTURE USE: should submit documents listed on letters A,
B, C, D1-4, E, L, M
PowER USE: should submit documents listed on letters A, B, D1, D3, E, F, K1-5 and Kg,
L, M
FlsHERlEs usE: should submit documents listed on letters A, B, D1, D3, D4, E,
F,.L, M
INDUSTRIAL USE: should submit documents listed on tetters A, B, D1, D3,
D4, E, F, l, K1, KZ, K4, K5, Kg L, M
LIVESTOCK USE: should submit documents listed on letters A, B, D1, D3,
D4, E, F, L, M
RECREATIONAL USE: documents listed on letters A, B, D1, D3, D4, E, F,
K1 , K2, KS, K7, L, M
OTHER USE: documents listed on letters A, B, D1, D3, D4, E, G, H, K1,l<2, KS,
L, M