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S.C.

________________________
Nr______Data ________________

CERERE

Subsemnat (ul/a)______________________________ domiciliat in _________________


Str. _____________________________nr. _____, bloc___, scara____, etaj___, ap.___,
judet/sector ___________, telefon_______________, act identitate _____, seria____,
nr_____________, CNP ________________________________ eliberat de _______________la
data__________, in calitate de_________________ la SC ______________________________
avand numar de ordine in registrul comertului _________________, cod unic de inregistrare
____________________, cu sediul social in localitatea _______________________ Str.
_____________________________, nr. _______, bloc_____, scara______, etaj_____,
ap._____, judet/sector _____________, cod postal _____________, casuta postala__________
telefon_______________, fax______________, e-mail_______________, solicit eliberarea
avizului de principiu conform legislatiei sanitare veterinare in vigoare, pentru urmatoarele
activitati (denumire activitate i cod CAEN):
_____________________________________________________________________________
_____________________________________________________________________________
__
_____________________________________________________________________________
_
care se vor desfasura la punctul de lucru situat in localitatea _________________________
str. ___________________________, nr. _____, bloc____, scara_____, etaj____, ap._____,
judet/sector _________________________, cod postal __________, casuta postala_________,
telefon____________________________, fax_____________________, e-mail_____________
Anexez alaturat urmatoarele documente :
- schia unitaii, cu fluxurile tehnologice;
- memoriul tehnic justificativ;
- planul de realizare a constructiei pentru fiecare etapa;
- proiectul de amplasare .

Data ______________

DSVSAB-FR-CAP

Semnatura si stampila ___________________