Lisa 1
Mõisaküla Linnavolikogu
22. september 2011 määrusele nr 11 

Mõisaküla Linnavalitsus

R A I E L O A      T A O T L U S

1. Taotleja nimi …………………………………………………………………………………........
 
2. Isikukood / registrikood ……………………………………………………………………….......
 
3. Aadress …………………………………………………………………………………................ 
 
4. Sidevahendite numbrid (telefon, e-post) …………………………………………………….........
 
5. Volitatud esindaja ………………………………………………………………………….......….

6. Kinnistusregistri number, katastritunnus, asukoht...........................................................................

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7. Raiutavad puud/arv/hoolduslõikus ......……………………………………………………............

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8. Puude raiumise/hoolduslõikuse põhjus(ed) ....………………………………………………......
 
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9. Puude raiumise/hoolduslõikuse orienteeruv aeg ..………………………………………............
 
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10. Raie teostaja              ……………………………………………………………………….........

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kuupäev                                                                                   taotleja allkiri