| Building or renovation of a home |
| Applicant |
| Name* : |
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| Adress* : |
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| Adress (2) : |
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| Email* : |
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| City* : |
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| Postal code* : |
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| Tel* : |
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| Project |
| Site |
| District ("Commune")* : |
|
| Plot ("Parcelle") : |
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| Section : |
|
| Number : |
|
| Area (m²) : |
|
| Type of project |
| Number of Home* : |
|
| Planning application * |
| permis de construire : |
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| Certificat d'urbanisme : |
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| Intended use |
| principal residence : |
|
| second home : |
|
| other (please indicate) : |
|
| indication : |
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| Number of bedrooms : |
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| Water supply |
| public supply : |
|
| well : |
|
Is there a well less than 35 meters from the site that can be used for
the water treatment system ? |
| yes : |
|
| no : |
|
| Foreman - architect |
| Name : |
|
| Adress : |
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| Adress (2) : |
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| Tel : |
|
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