Operator economic autorizat ANRE

Nr. intrare / Data

//Cerere

privind solicitarea de emitere aviz traseu / amplasament / principiuCtre S.C. Distrigaz Sud Reele S.R.L.1. Subscrisa ..............................................., cod unic de nregistrare CUI reprezentat legal prin , legitimat cu, BI/CI seria , nr. , eliberat la data

CONTROL Forms.TextBox.1 -

CONTROL Forms.TextBox.1 -

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1 de , CNP

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1 , n calitate de , telefon contact: .................2. Subsemnatul , legitimat cu BI/CI seria , nr. , eliberat la data

CONTROL Forms.TextBox.1 -

CONTROL Forms.TextBox.1 -

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1 , de ,CNP

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1

CONTROL Forms.TextBox.1 , telefon contact: ............................. v rog s aprobai eliberarea avizului de traseu / amplasament / principiu, pentru:

Titularul CERTIFICATULUI DE URBANISM /beneficiar:

,Amplasamentul

Localitatea: ,Str.

, nr. , bl. , sc. ,Sector / jude .Acte anexate:

Certificatul de Urbanism (copie);

Memoriul tehnic privind lucrarea de construire avut n vedere;

Plan ncadrare n zon, scara 1:25000 sau scara 1:10000

(dou exemplare);

Plan de situaie , scara 1:500

(dou exemplare);

Alte acte:;n calitate de mputernicit / titular al Certificatului de urbanism, declar pe propria rspundere c:

am luat la cunotin de consecinele privind falsul n declaraii prevzute de art. 292 din Codul Penal;

am luat la cunotin lista privind tarifele practicate de Operatorul de distribuie Distrigaz Sud Reele;

sunt de acord cu prelucrarea datelor cu caracter personal, n conformitate cu dispoziiile Legii 677/2001.

Data:

Semntura:............................................................

................................................(loc pentru completarea de ctre Operatorul sistemului de distribuie gaze naturale Distrigaz Sud Reele)

Achitat cu:nr. , data: //Obs.:

A.lucrri de construire ( noi CONTROL Forms.TextBox.1 modificare CONTROL Forms.TextBox.1 deviere CONTROL Forms.TextBox.1 )

lucrri de dezafectare/demolare/desfiintare CONTROL Forms.TextBox.1

altele:

PAGE FD-185 - 401 C2 - PUBLIC

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