<p style='text-align: center;'><span class='mce_maj' style='font-size: 14pt; font-family: helvetica;'><span style='font-weight: bold;'><span class='field_value pre'><span style='font-size: 14pt; font-family: helvetica;'>Dossier <span style='font-weight: bold;'>de<span class='field_value pre mce_maj'> [libelle_datd] </span></span></span></span></span></span></p>
<p style='text-align: center;'><span class='mce_maj' style='font-size: 14pt; font-family: helvetica;'><span style='font-weight: bold;'><span class='field_value pre'>[libelle_om_lettretype]</span> </span></span></p>
<p style='text-align: justify;'> </p>
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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><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'><br /></span></span></span>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> </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]<br /></span></span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[nom_petitionnaire_principal]</span></p>
<p> </p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[numero_petitionnaire_principal] [voie_petitionnaire_principal]</span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[complement_petitionnaire_principal] - [lieu_dit_petitionnaire_principal]</span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[bp_petitionnaire_principal]</span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[code_postal_petitionnaire_principal] [localite_petitionnaire_principal] [cedex_petitionnaire_principal] </span></p>
<p><span class='mce_maj' style='font-family: helvetica; font-size: 10pt; font-weight: bold;'>[pays_petitionnaire_principal]</span></p>
<p> </p>
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<td colspan='2'>
<p style='text-align: center;'><span style='font-size: 8pt; font-family: helvetica;'><span style='text-decoration: underline;'><em>Affaire suivie par</em></span> : </span><span class='mce_maj' style='font-family: helvetica; font-size: 8pt;'>&amp;adresse_direction_urbanisme</span></p>
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