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["別記第一号様式（第４条関係）"]
[]
["建築物（宅地開発）事業計画協議申出書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
["岐南町長　様"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"申出者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]
[]
["岐南町建築物等の適正化に関する指導要綱第４条の規定により申出をします。"]
[]
["記"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□・・・該当にチェック"]
[]
["概　　　要",null,null,"計　　　画"]
["　１　土地の所在",null,null,"羽島郡岐南町"]
[]
["　２　土地の面積",null,null,"田",null,null,null,"㎡","畑",null,null,null,null,"㎡","宅地",null,null,null,null,"㎡","（その他）",null,null,null,null,null,"㎡"]
[]
[null,null,null,"敷地面積の合計",null,null,null,null,null,null,null,"㎡"]
[]
["　３　都市計画の別",null,null,"□","市街化区域 （ 用途地域 ：",null,null,null,null,null,null,"　",null,null,null,null,null,null,null,"）",null,"□","市街化調整区域"]
[]
["　４　事業目的",null,null,"□","住宅",null,"□","共同住宅・長屋",null,null,null,null,"□","店舗　（",null,"□","飲食",null,"□","物販　）",null,null,"□","事務所"]
[]
[null,null,null,"□","工場（作業場）",null,null,null,null,"□","倉庫",null,"□","その他　（",null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,"計画建築物の概要",null,null,null,null,"：（","棟数",null,null,null,"）",null,null,"階建",null,"（","延床面積",null,null,null,null,null,"㎡","）"]
[]
["　５　道路計画",null,null,null,"敷地のうち、都市計画道路に含まれる部分の面積",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㎡"]
[]
[null,null,null,null,"敷地のうち、町道整備計画路線に含まれる部分の面積",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㎡"]
[]
["　６　接道（幅員）",null,null,"□","東","（",null,null,"m)","□","西","（",null,null,"m）","□","南","（",null,null,"m）","□","北","（",null,null,"m)"]
[]
["　７　排水方法",null,null,"雨水の放流先 ：",null,null,null,null,null,null,null,null,null,null,null,null,"汚水の放流先："]
[]
["　８　流末処理",null,null,"（汚水の処理）",null,null,null,"□","公共下水",null,null,"□","合併処理浄化槽",null,null,null,null,"□","その他",null,"（",null,null,null,null,null,null,"）"]
[]
["　９　駐車場",null,null,"設置",null,null,null,"台",null,"（必要",null,null,null,"台）",null,"または",null,"駐車スペースの面積",null,null,null,null,null,null,null,null,"㎡"]
[]
["　１０　同意等",null,null,"（排水同意等）",null,null,null,"□","羽島用水土地改良区事務所",null,null,null,null,null,null,null,null,"□","岐南町",null,null,null,"□","国土交通省"]
[]
["　１１　その他",null,null,"　（町への連絡欄）"]
[]
[]
["　協議に付した\n　条件等"]
[]
["　受付年月日",null,null,"　　　　　　　　年　　　　月　　　　日"]
[]
["　協議番号",null,null,"　岐南第　　　　　　　　号"]
[]
[]
["【提出書類 / 綴り順】　　※提出は２部（正・副）となります"]
["①本協議申出書　 ②委任状　 ③承諾書　 ④確約書（町道整備計画路線による道路拡幅に該当する場合のみ）　⑤位置図（案内図）　 ⑥公図（字絵図）の写し　 ⑦求積図（敷地面積のわかるもの）　 ⑧土地利用計画図（配置図・駐車場計画図）　⑨排水計画図（雨水・汚水共 ⑧の土地利用計画図に記載可）　⑩建築図等　 ⑪その他"]

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["別記第一号様式（第４条関係）"]
[]
["建築物（宅地開発）事業計画協議申出書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和○○",null,null,null,"年",null,"○○",null,"月",null,"○○",null,"日"]
["岐南町長　様",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"羽島郡岐南町八剣7-107"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"申出者",null,null,null,null,null,"岐南　太郎"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]
[]
["岐南町建築物等の適正化に関する指導要綱第４条の規定により申出をします。"]
[]
["記"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□・・・該当にチェック"]
[]
["概　　　要",null,null,"計　　　画"]
["　１　土地の所在",null,null,"羽島郡岐南町",null,null,null,"八剣七丁目107番地"]
[]
["　２　土地の面積",null,null,"田",null,null,null,"㎡","畑",null,55,null,null,"㎡","宅地",null,123.8,null,null,"㎡","（その他）",null,null,null,null,null,"㎡"]
[]
[null,null,null,"敷地面積の合計",null,null,null,null,178.8,null,null,"㎡"]
[]
["　３　都市計画の別",null,null,"■","市街化区域 （ 用途地域 ：",null,null,null,null,null,null,"第1種住居地域",null,null,null,null,null,null,null,"）",null,"□","市街化調整区域"]
[]
["　４　事業目的",null,null,"■","住宅",null,"□","共同住宅・長屋",null,null,null,null,"□","店舗　（",null,"□","飲食",null,"□","物販　）",null,null,"□","事務所"]
[]
[null,null,null,"□","工場（作業場）",null,null,null,null,"□","倉庫",null,"□","その他　（",null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,"計画建築物の概要",null,null,null,null,"：（","棟数",null,1,null,"）",2,null,"階建",null,"（","延床面積",null,null,110.5,null,null,"㎡","）"]
[]
["　５　道路計画",null,null,null,"敷地のうち、都市計画道路に含まれる部分の面積",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,"㎡"]
[]
[null,null,null,null,"敷地のうち、町道整備計画路線に含まれる部分の面積",null,null,null,null,null,null,null,null,null,null,null,null,null,null,12,null,null,null,"㎡"]
[]
["　６　接道（幅員）",null,null,"□","東","（",null,null,"m)","■","西","（",3.8,null,"m）","■","南","（",5.2,null,"m）","□","北","（",null,null,"m)"]
[]
["　７　排水方法",null,null,"雨水の放流先 ：",null,null,null,null,"排水路",null,null,null,null,null,null,null,"汚水の放流先：",null,null,null,null,"公共下水"]
[]
["　８　流末処理",null,null,"（汚水の処理）",null,null,null,"■","公共下水",null,null,"□","合併処理浄化槽",null,null,null,null,"□","その他",null,"（",null,null,null,null,null,null,"）"]
[]
["　９　駐車場",null,null,"設置",null,2,null,"台",null,"（必要",null,1,null,"台）",null,"または",null,"駐車スペースの面積",null,null,null,null,null,null,null,null,"㎡"]
[]
["　１０　同意等",null,null,"（排水同意等）",null,null,null,"■","羽島用水土地改良区事務所",null,null,null,null,null,null,null,null,"□","岐南町",null,null,null,"□","国土交通省"]
[]
["　１１　その他",null,null,"　（町への連絡欄）"]
[null,null,null,"※敷地について、特に必要な事項（連絡）がありましたら、記載してください。"]
[]
["　協議に付した\n　条件等",null,null,"（これより下は、町が記載します）"]
[]
["　受付年月日",null,null,"　　　　　　　　年　　　　月　　　　日"]
[]
["　協議番号",null,null,"　岐南第　　　　　　　　号"]
[]
[]
["【提出書類 / 綴り順】　　※提出は２部（正・副）となります"]
["①本協議申出書　 ②委任状　 ③承諾書　 ④確約書（町道整備計画路線による道路拡幅に該当する場合のみ）　⑤位置図（案内図）　 ⑥公図（字絵図）の写し　 ⑦求積図（敷地面積のわかるもの）　 ⑧土地利用計画図（配置図・駐車場計画図）　⑨排水計画図（雨水・汚水共 ⑧の土地利用計画図に記載可）　⑩建築図等　 ⑪その他"]