Ctre,

PRIMRIA COMUNEI TEACA

Subsemnatul______________________________________CNP/CUI_________________,
domiciliat n judeul ________________municipiul____________sector_______cod potal______,
strada_____________________________nr.________bl.______,sc______et________ ap_______
telefon/fax____________________________e-mail_____________________________________,
v rog prin prezenta eliberarea unui plan de situaie, scara _________________________
pentru urmtorul amplasament/ urmtoarele amplasamente ________________________________
________________________________________________________________________________
________________________________________________________________________________

Cu multumiri,

Data:________________
Semntura_________________

L.S.