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CERERE Subsemnatul(a), ............................................................................................................, cu domiciliul n localitatea ...................................................... sector/judecul.......................................... str. ............. .........................................................................nr.........., bl..........sc........et........ap................................... posesor/posesoare al/a BI/CI seria ........... nr. ....................., eliberat de ..................................... la data de...................................., n calitate de ................................................................al ......................... ................................................................................................................., cu sediul n ............................ str......................................................................nr..........bl..........sc........ap.......sector/judet.....................telefon ..............................., fax..................................., e-mail & & & & & & & & .@........................ nmatriculat la registrul comercului sub nr. ........................................, avnd codul fiscal nr. .............................. din ............................, solicit, viz anual la autorizacia sanitar n baza referatului de evaluare pentru ................................................................................................................................................. , situat la (adresa): Str................................................... nr. ............ bl.............sc..............et............ap..... localitatea............................................................judetul................................................... avnd ca obiect de activitate (cod CAEN)............................................................................................... & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & .. structura funccional: ............................................................................................................................... .................................................................................................................................................................. ................................................................................................................................................................... ................................................................................................................................................................... Anexez la cerere documentacia solicitat, complet, _i anume: documentacia tehnic - memoriu tehnic - plan incadrare in zona cu plan de situatie - schice cu detalii de structur funccional b) document autentificat care s ateste decinerea legal a spaciului, acceptul vecinilor, asociaciei de proprietari; c) cod fiscal, certificatul constatator de la Registrul Comercului d) contract colectare _i incinerare de_euri medicale e) autorizacia sanitar de funccionare n original f) avizul de la Ministerul Sntcii (cu aprobare structur funccional - nr. de paturi) pentru spitalizare g) chitanca de plat a tarifului de autorizare sanitar nr. ......................... din data de .................., n valoare de 400 lei (la trezorerie in contul RO40TREZ67120160103XXXXX  bugetul statului, cod fiscal DSP Valcea - 11286391) h) alte documente care s ateste ndeplinirea c  BIJK 4,.02BDʽziXiKhQ5CJOJQJaJ!heT5CJOJQJaJmHsH!hIU5CJOJQJaJmH sH !hfk5CJOJQJaJmH sH h!v55CJOJQJaJhDhZCJOJQJaJhCJOJQJaJh5CJOJQJaJh5CJ OJQJaJ hCJOJQJaJh?Vh]ECJaJmH sH h?VCJaJmH sH h?VhfkCJaJmH sH  IJK%m"`R $X^Xa$gd2&% $ & Fa$gd2&% $^a$gd$a$gdgdgd0JDFH Sfkz"#$%_lm ٽٽٽɢ٢Ƀ٢٢٢٢٢٢$hUhUCJOJQJaJmH sH hUCJOJQJaJh!v5CJOJQJaJhuhuCJOJQJaJhuCJOJQJaJhUCJOJQJaJmH sH hCJOJQJaJhQ5CJOJQJaJh5CJOJQJaJ- "`(PRtṩ{o`M$ha@ha@CJOJQJaJmHsHha@ha@CJOJQJaJha@CJOJQJaJh CJOJQJaJh h CJOJQJaJ$h2&%h2&%CJOJQJaJmH sH h2&%CJOJQJaJmH sH hCJOJQJaJmH sH hDhZCJOJQJaJheTCJOJQJaJhCJOJQJaJ$hS2hCJOJQJaJmH sH :<Zxz4PRdRи踬謸ܸĜČ|hS2CJOJQJaJmH sH h|CJOJQJaJmH sH hW4CJOJQJaJmH sH hdCJOJQJaJhKCJOJQJaJh!v5CJOJQJaJhCJOJQJaJhDhZCJOJQJaJheTCJOJQJaJhQCJOJQJaJ)RZv./123f3h3777888888$a$gd9Cx$a$gd9Cx $a$gd9Cx$a$gd$L^`La$gd!v5$L^`La$gd .. .v.//0001122233f3h345566666ŷŪnn]]]]]UQQUh9Cxjh9CxU hh9CxCJOJQJ^JaJ#hh9Cx5CJOJQJ^JaJh5CJOJQJaJhfkCJOJQJaJ!hfk5CJOJQJaJmH sH hfk5CJOJQJaJheTCJOJQJaJUh!v5CJOJQJaJheCJOJQJaJmH sH hCJOJQJaJ$h|hDhZCJOJQJaJmH sH erincelor legale incidente domeniului .................... ........................................................................................................................................................ Documentele mencionate vor fi depuse in original sau n copie cu menciunea  conform cu originalul _i vor fi semnate _i _tampilate de ctre solicitant Data ......./........./............. Semntura ........................... Consimmnt prelucrare date cu caracter personal Prin semnarea prezentei mi asum rspunderea asupra corectitudinii, exactitii i veridicitii datelor nscrise n prezenta cerere i mi exprim acordul ca DSP Vlcea s-mi utilizeze datele cu caracter personal pentru prelucrarea automat i manual, stocare, arhivare i transmitere la Ministerul Sntii conform prevederilor Ordinului MS nr.1059/2003. De asemenea, am luat la cunotin de pe site-ul HYPERLINK "http://www.aspjvalcea.ro"www.aspjvalcea.ro despre drepturile privind datele cu caracter personal prevzute n Legea nr. 190/2018 i Regulamentul UE nr.679/2016. Data ......./........./............. Semntura ........................... DECLARATIE Subsemnatul& & & & & & & & & & & & & & & & .. cu domiciliul in localitatea& & & & & & & & & & & & & & & str& & & & & & & & & & & nr& & in calitate de& & & & & & & & & & .al& & & & & & & & & & & & & & & avand codul fiscal& & & & & & & & & & & & & , cunoscand faptul ca falsul in declaratii este pedepsit de legea penala, declar pe propria raspundere ca spatiul(adresa)& & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . este detinut legal si nu face obiectul vreunui litigiu.      MINISTERUL SNTbII DIRECbIA DE SNTATE PUBLIC VALCEA STR. 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