<p style='text-align: left;'> </p>
<p style='text-align: center;'><span class='mce_maj' style='font-weight: bold; font-size: 12pt; font-family: helvetica;'><span class='field_value pre'>[libelle_om_lettretype]</span> </span></p>
<p style='text-align: center;'> </p>
<p style='text-align: left;'> </p>
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<p><span style='font-size: 10pt; font-family: helvetica;'><span style='font-size: 12pt;'><span style='font-size: 10pt; font-family: helvetica;'>Dossier :      </span></span><span style='font-weight: bold; font-size: 12pt;'><span style='font-size: 10pt; font-family: helvetica;'> <span style='font-weight: bold; font-size: 12pt;'><span class='field_value pre'><span class='field_value pre'>[libelle_dossier]</span></span></span></span></span></span></p>
<p><span style='font-size: 10pt; font-family: helvetica;'>Déposé le :   <span class='field_value pre'><span class='field_value pre'><span class='field_value pre'><span class='field_value pre'>[date_depot_dossier]</span></span></span></span></span></p>
<p><span style='font-size: 10pt; font-family: helvetica;'><span style='text-decoration: underline;'>Adresse des travaux</span> :</span></p>
<p><span class='field_value pre' style='font-size: 10pt; font-family: helvetica; font-weight: bold;'><span class='field_value pre mce_maj'>[terrain_adresse_voie_numero_dossier] [terrain_adresse_voie_dossier]</span></span></p>
<p><span class='field_value pre' style='font-size: 10pt; font-family: helvetica; font-weight: bold;'><span class='field_value pre mce_maj'>[terrain_adresse_lieu_dit_dossier] </span><span class='field_value pre mce_maj'>[terrain_adresse_bp_dossier]</span></span></p>
<p><span class='field_value pre' style='font-size: 10pt; font-family: helvetica; font-weight: bold;'><span class='field_value pre mce_maj'>[terrain_adresse_code_postal_dossier] [terrain_adresse_localite_dossier] [terrain_adresse_cedex_dossier]</span></span></p>
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<td>
<p><span style='font-family: helvetica; font-size: 10pt;'><span style='text-decoration: underline;'>Demandeur</span> :       <span class='mce_codebarre'>[code_barres_instruction]</span></span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[nom_correspondant]</span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[numero_correspondant] [voie_correspondant] [complement_correspondant] - [lieu_dit_correspondant]</span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[bp_correspondant]</span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[code_postal_correspondant] [ville_correspondant] [cedex_correspondant]</span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[pays_correspondant]</span></p>
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<p style='text-align: left;'><span style='font-size: 8pt; font-family: helvetica;'><span style='text-decoration: underline;'><em>Affaire suivie par</em></span> : <span class='field_value pre'><span class='field_value pre'>[nom_instructeur] -<span style='font-family: helvetica;'><span class='field_value pre'><span class='field_value pre'> Division [division_instructeur]</span></span></span> - [telephone_instructeur] - [email_instructeur]</span></span></span></p>
<p style='text-align: center;'><span class='mce_maj' style='font-family: helvetica; font-size: 8pt;'>&amp;adresse_direction_urbanisme</span></p>
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