<p style='text-align: center;'> </p>
<p style='text-align: center;'><span class='mce_maj' style='font-size: 14pt; font-family: helvetica; font-weight: bold;'>Ville &amp;delaville</span></p>
<p style='text-align: center;'> </p>
<p style='text-align: center;'><span class='mce_maj' style='font-size: 12pt; font-family: helvetica;'><span style='font-weight: bold;'><span class='field_value pre'>[libelle_om_lettretype]</span></span></span><span style='font-size: 14pt; font-family: helvetica;'> <span style='font-weight: bold;'><span class='mce_maj' style='font-size: 12pt;'>de</span><span class='field_value pre mce_maj'><span style='font-size: 12pt;'> [libelle_datd]</span><br /></span></span></span></p>
<p style='text-align: justify;'> </p>
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<tbody>
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<td style='width: 60%;'>
<p><span class='mce_codebarre' style='font-size: 10pt; font-family: helvetica;'>[code_barres_dossier]</span></p>
<p><span style='font-size: 10pt; font-family: helvetica;'>Dossier : <span style='font-weight: bold; font-size: 12pt;'><span class='field_value pre'><span class='field_value pre'>[libelle_da]</span></span></span></span></p>
<p> </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> </p>
<p><span style='font-size: 10pt; font-family: helvetica;'><span style='text-decoration: underline;'>Adresse des travaux</span> :</span></p>
<p><span style='font-family: helvetica; font-size: 10pt;'> </span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt;'><span class='field_value pre' style='font-weight: bold;'><span class='field_value pre'>[terrain_adresse_voie_numero_dossier] [terrain_adresse_voie_dossier] </span></span></span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt;'><span class='field_value pre' style='font-weight: bold;'><span class='field_value pre'>[terrain_adresse_lieu_dit_dossier] [terrain_adresse_bp_dossier]</span></span></span></p>
<p><span class='field_value pre mce_maj' style='font-size: 10pt; font-family: helvetica; font-weight: bold;'><span class='field_value pre'>[terrain_adresse_code_postal_dossier] [terrain_adresse_localite_dossier] [terrain_adresse_cedex_dossier]</span></span></p>
<p><span style='font-family: helvetica; font-size: 10pt;'> </span></p>
<p><span style='font-family: helvetica; font-size: 8pt;'><span style='font-family: helvetica;'><span style='text-decoration: underline;'>Parcelle :</span><br /><span class='mce_maj' style='font-weight: bold;'>[terrain_references_cadastrales_dossier]</span></span></span></p>
<p><span style='font-size: 8pt;'><span class='field_value pre' style='font-family: helvetica;'><span class='field_value pre'><span style='text-decoration: underline;'><span class='mce_maj'>o</span>bjet :</span></span></span><span class='field_value pre mce_min' style='font-family: helvetica; font-weight: bold;'><span class='field_value pre'><br /></span></span><span class='field_value pre mce_maj' style='font-family: helvetica; font-weight: bold;'><span class='field_value pre'>[co_projet_desc_donnees_techniques]</span></span></span></p>
<p> </p>
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<td>
<p style='text-align: justify;'><span style='font-family: helvetica; font-size: 10pt;'><span style='text-decoration: underline;'>Demandeur</span> : <span class='mce_codebarre'>[code_barres_instruction]<br /></span></span></p>
<p style='text-align: left;'><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[nom_correspondant]</span></p>
<p style='text-align: left;'> </p>
<p style='text-align: left;'><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[numero_correspondant] [voie_correspondant]</span></p>
<p style='text-align: left;'><span class='mce_maj' style='font-size: 10pt;'><span style='font-family: helvetica; font-weight: bold;'>[complement_correspondant] - [lieu_dit_correspondant]</span></span></p>
<p style='text-align: left;'><span class='mce_maj' style='font-size: 10pt;'><span style='font-family: helvetica; font-weight: bold;'>[bp_correspondant]</span></span></p>
<p style='text-align: left;'><span class='mce_maj' style='font-size: 10pt;'><span style='font-family: helvetica; font-weight: bold;'>[code_postal_correspondant] [ville_correspondant] [cedex_correspondant]</span></span></p>
<p style='text-align: left;'><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[pays_correspondant]</span></p>
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<td colspan='2'>
<p style='text-align: center;'><span style='font-family: helvetica; font-size: 8pt;'>Si vous souhaitez obtenir des informations sur votre dossier, adressez-vous:</span></p>
<p style='text-align: center;'><span style='font-family: helvetica; font-size: 8pt;'>Commune &amp;DELAVILLE</span></p>
<p style='text-align: center;'><span style='font-family: helvetica; font-size: 8pt;'>&amp;adresse_service_municipal_empl</span></p>
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