1 (1) BLANKETT Skapat av (Efternamn Förnamn, org) Dokumentdatum Ärendenummer [Skapat av NY] [Dokumentdatum NY] [Ärendenummer NY] Dokumenttitel Samråds synpunktsformulär – Gammelgården väg 721 E-post Namn Ev. förening el dyl. Adress Telefonnummer Postadress Lämna synpunkter här: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ TMALL 0108 Mall Samråd synpunktsformulär ver. 2.0 DOK 2010:31 Grundmall_Blankett ver. 1.0 ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Inlämnade synpunkter diarieförs och blir därmed offentliga. Synpunkter lämnas senast 2016-12-30, till Trafikverket, Ärendemottagning Region Nord, Box 810, 781 28 Borlänge. Väljer ni att skicka synpunkter via mejl kan ni skicka dessa till [email protected]. Ange diarienummer TRV 2015/30688. För mer information kontakta Simon Lövgren, projektledare, 010-123 74 24, [email protected].