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Traffic Clearance/Excavation Permit
MMDA form for road diggings
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: REPUBLIKA NG PILIPINAS
TANGGAPAN NG PANGULO
Pangasiwaan Sa Pagpapaunlad Ng Kalakhang Maynila
(Metropolitan Manila Development Authority)
“Kasama Ako sa Pagbabago”
TRAFFIC CLEARANCE/EXCAVATION PERMIT
(Application Form)
Date
Pursuant to the provision of R.A. 7924 Section 3-B and of MMDA Ordinance No. 2 Series of
1991 amending MMDA Ordinance No. 82-01 as amended by MMDA Regulation No. 11002 Series of 2011 filing of Application and Issuance of Excavation Permit Affecting
National and Local Roads, to wit;
1.
Name of Contractor/Permitee : ______________________________________
2.
Address of Contractor : ___________________________________________
_______________________________________________________________
3.
Implementing Agency : ___________________________________________
4.
Address of Implementing Agency : __________________________________
5.
Source of Funds:
_____________________________________________
(Allocation of Budget)
6.
Project In-Charge : _______________________________________________
7.
Type of Activity/Project : __________________________________________
8.
Location/Area covered : ___________________________________________
9.
Length/Width of Excavation : ______________________________________
10.
Type of Pavement : _______________________________________________
11.
Number of Days/Duration : _________________________________________
Name of Contractor / Permitee
By:
Representative Signature over Printed Name
Tel. No.
Cel. No. _____________________________
