February 22, 2021

IGACOS WATER DISTRICT

Cor. Magsaysay & Rizal St.
Brgy. Pob. Penaplata, Samal Dist.
Island Garden City of Samal,
Davao Del Norte, 8119

AUTHORIZATION LETTER

I, (Name of the Owner) of legal age, Filipino, a resident of Barangay Anonang,

Kaputian District, Island Garden City of Samal after having been sworn to in accordance
with law, shall depose and say;

That I have hereby authorized and permitted (Name of the person asking
permission) to use a portion of my land for water service connection, he is now allowed
and permitted to do so.

Land Owner Name and Signature