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 şi 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 :
- schiţa unitaţii, cu fluxurile tehnologice; - memoriul tehnic justificativ; - planul de realizare a constructiei pentru fiecare etapa; - proiectul de amplasare .
Data ______________ Semnatura si stampila ___________________