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[]
[]
["申請出力"]
[null,null,null,null,null,null,null,null,null,null,null,null,"入力時の注意事項"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"黄色のセル：必要箇所の入力をしてください。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"橙色のセル：チェック又は必要事項の選択をしてください。"]
["実績報告\n出力"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"灰色のセル：自動で入力、計算が反映されるため、入力しないでください。"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,"※補助事業者あてに依頼をする際に使用してください。"]
[]
[]
["変更等承認\n申請　出力"]

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[null,"様式第１号（第６条関係）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"補　助　金　交　付　申　請　書"]
[null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日"]
[null,"岡 山 市 長   様"]
[]
[null,null,"令和",null,null,null,null,"年度において、合併処理浄化槽を設置するにあたり、岡山市合併処理浄化槽設置"]
[null,"整備事業補助金交付要綱第６条の規定により、次のとおり補助金の交付を申請します。"]
[null,null,"申請に当たっては、岡山市補助金等交付規則及び岡山市合併処理浄化槽設置整備事業補助金"]
[null,"交付要綱の規定の適用を受けることについて同意します。"]
[null,null,"また、この申請書及び添付書類の記載事項は、事実に相違ありません。"]
[null,null,"なお、建物が共有名義の場合、共有者全員同意のもと私が代表して申請します。"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"〒"]
[null,null,null,null,null,null,null,null,null,null,"住　所"]
[null,"申請者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,"フリガナ"]
[]
[null,"( 設置者 )",null,null,null,null,null,null,null,null,"氏　名"]
[]
[null,null,null,null,null,null,null,null,null,null,"(連絡先ＴＥＬ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,"私は岡山市合併処理浄化槽設置整備事業補助金の申請事務手続に関する　"]
[null,"手続きを\n代行させる\n場合",null,null,null,null,null,null,null,null,"すべての事項を次の者に委任します。"]
[]
[null,null,null,null,null,null,null,null,null,null,"手続き代行者",null,null,null,null,null,null,null,null,null,"住所"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名又は名称"]
[]
[]
[]
[null,"設置場所",null,null,null,null,null,null,null,null,null,"岡山市"]
[]
[null,"設置する浄化槽",null,null,null,null,null,null,null,null,null,"メーカー",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人槽",null,null,null,null,"全浄協登録番号"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"機種",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"型式認定番号"]
[]
[null,"補助金申請額\n※裏面備考参照",null,null,null,null,null,null,null,null,null,"合計(A)+(B)+(C)",null,null,null,null,null,null,null,null,null,"金",null,{"$f":"AI42+AI43+AI44","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,"浄化槽設置分(上限)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(A)","金",null,null,null,null,null,null,null,null,null,null,null,null,"円",null,"(",null,null,null,null,null,null,"円",null,")"]
[null,null,null,null,null,null,null,null,null,null,null,"（単独・汲取り）宅内配管工事分(上限)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(B)","金",null,null,null,null,null,null,null,null,null,null,null,null,"円",null,"(",null,null,null,null,null,null,"円",null,")"]
[null,null,null,null,null,null,null,null,null,null,null,"（単独・汲取り）撤去工事分(上限)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(C)","金",null,null,null,null,null,null,null,null,null,null,null,null,"円",null,"(","　",null,null,null,null,null,"円",null,")"]
[null,"事業費見積額\n※裏面備考参照",null,null,null,null,null,null,null,null,null,"合計(D)+(E)+(F)+(G)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金",null,{"$f":"V48+AT46+AT47+AT48","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,"浄化槽本体価格",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,"宅内配管工事費(E)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,"埋設工事費",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,"撤去工事費(F)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,"小計（D）",null,null,null,null,null,null,null,null,null,{"$f":"V46+V47","v":0},null,null,null,null,null,null,null,null,null,null,null,"円",null,"消費税(G)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,"住宅所有者",null,null,null,null,null,null,null,null,null,"■",null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,"住宅の種類",null,null,null,null,null,null,null,null,null,null,null,"一般住宅",null,null,null,null,null,null,null,null,null,null,null,null,null,"延べ床面積",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㎡"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"店舗等併用住宅",null,null,null,null,null,null,null,null,null,null,null,null,null,"延べ床面積",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"X52+AT52","v":0},null,null,null,null,null,null,null,null,null,null,null,null,"㎡"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"居住部分の床面積",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㎡","その他の部分の床面積",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㎡"]
[null,"工事の予定期間",null,null,null,null,null,null,null,null,null,null,null,null,null,"交付決定日以降",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～",null,null,"令和",null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日"]
[null,"放流先",null,null,null,null,null,null,null,null,null,"■",null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,"浄化槽工事業者",null,null,null,null,null,null,null,null,null,"商号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"岡山県登録(届出)番号"]
[null,"浄化槽設備士",null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"免状(修了)番号"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"住所",null,null,null,{"$f":"P17","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,"ﾌﾘｶﾞﾅ",null,null,null,{"$f":"P19","v":0}]
[]
[null,"岡山市内\n居住者\nの場合",null,null,null,null,null,null,null,null,"氏名",null,null,null,{"$f":"P21","v":0}]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,"私の市税に係る徴収金の滞納有無について岡山市長が調査・確認すること及び"]
[null,null,null,null,null,null,null,null,null,null,"補助金事務手続きを他者に委任している場合、調査結果を手続き代行者に知らせる"]
[null,null,null,null,null,null,null,null,null,null,"ことについて"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"同意します。(生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日",null,")"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"同意しません。(滞納無証明書を添付します。)"]
[]
[]
[]
[null,"備考"]
[null,null,"※補助金申請額について"]
[null,null,null,"(A)欄には、上限と(D)を比較していずれか少ない方の額を記入してください。"]
[null,null,null,"(B)欄には、上限と(E)を比較していずれか少ない方の額を記入してください。"]
[null,null,null,"(C)欄には、上限と(F)を比較していずれか少ない方の額を記入してください。"]
[null,null,"※事業費見積額について"]
[null,null,null,"浄化槽設置工事分(※配管工事費を含まない)を(D)欄に記入してください。"]
[null,null,null,"単独転換又は汲取り転換に伴う宅内配管工事補助を申請する場合は(E)の欄にも記入してください。"]
[null,null,null,"単独処理浄化槽又は汲取り便槽撤去に伴う撤去工事補助を申請する場合は(F)の欄にも記入してください。"]
[null,null,null,"(D),(E),(F) には消費税及び地方消費税の額を含まずに，１，０００円未満は切捨てた額を"]
[null,null,null,"記入してください。"]
[]
[]
[null,"ここから下は記入しないでください。"]
[]
[null,"岡山市記載分"]
[]
[null," 市税滞納有無"]
[null,null,"□調査不要( 市外居住者　　市内居住者で滞納無証明書添付 )"]
[null,null,"□調査要"]
[null,null,null,null,null,"調査日",null,null,null,null,null,"／",null,null,null,null,null,"確認者"]
[null,null,null,"□滞納無"]
[null,null,null,"□滞納有",null,null,null,null,null,"□不明(氏名 住所 生年月日)不一致,該当者無 ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"→",null,null,"ダブルチェックへ"]
[null,null,null,null,null,"滞納無が確認できなかった場合のダブルチェック",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査日",null,null,null,null,null,"／",null,null,null,"確認者"]
[null,null,null,"□滞納無"]
[null,null,null,"□滞納有",null,null,null,null,null,"□不明(氏名 住所 生年月日)不一致,該当者無 ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"→",null,"□後日、滞納無証明書提出済"]

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[]
[null,null,null,null,null,null,null,null,null,null,"合併浄化槽設置補助金申請審査票"]
[]
[null,"太線の中を記入し、該当する項目にチェック(レ)してください。"]
[]
["年度",null,null,{"$f":"'交付申請書 (2)'!F8","v":0},null,null,null,null,null,null,null,null,"番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"正式　　 ／"]
[]
["申請者\n氏名",null,null,null,null,null,null,{"$f":"'交付申請書 (2)'!P21","v":0}]
[]
["設置場所",null,null,null,null,null,null,"岡山市",null,null,null,null,{"$f":"'交付申請書 (2)'!R35","v":0}]
["工事業者",null,null,null,null,null,null,{"$f":"'交付申請書 (2)'!O55","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話"]
["申請手続",null,null,null,null,null,null,{"$f":"'交付申請書 (2)'!AD31","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者",null,null,null,null,null,null,null,null,null,null,"電話"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請人槽",null,null,null,null,{"$f":"'交付申請書 (2)'!AD37","v":0},null,null,null,null,"人槽",null,null," 使用予定人員",null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[]
["補助金申請"]
["新築・増築・建替・埋替"]
["設置場所の今までの汚水処理"]
["住民票事前異動"]
["申請者の現住所\n（住民票事前異動ありの\n場合は異動前住所）"]
["生活の本拠に設置"]
["物件の所有者等"]
[]
["特 記\n事 項"]
[null,null,null,null,null,null,null,"滞納無証明書",null,null,null,null,null,null,null,null,null,null,null,"住民票",null,null,null,null,null,null,null,null,null,"11条検査結果・汲取り伝票・水道検針票等"]
[]
[null,null,null,null,null,null,null,"理由書",null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,null,null,null,"承諾書",null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,null,null,null,"公共物使用許可",null,null,null,null,null,null,null,null,null,null,null,"ポンプ放流",null,null,null,null,null,null,null,null,null,"併用住宅",null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,null,null,null,"その他",null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,null,null,null,"撤去",null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
[null,null,null,null,null,"岡山市税滞納有無については申請書裏面に記載"]
[]
[]
[null,null,null,null,"日 付",null,null,null,null,null,"指　　　　　摘　　　　　事　　　　　項",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担  当"]
[]
["受 付"]
[]
["入 力"]
[]
["係 員"]
[]
[]
[]
["室 長"]
[]
["連 絡"]

{"sheet":"覚書 (2)","index":3,"n_rows":35,"n_cols":17,"rows_kept":35,"cut":false,"hidden":false,"merged":[[26,14,26,16],[0,0,0,2],[22,14,22,16],[4,1,4,2],[14,3,14,4],[19,14,19,15],[13,2,13,10],[16,3,16,10],[18,3,18,10],[20,9,20,10],[20,3,20,5]]}
["浄化槽工事の適正な施工の確保に関する覚書",null,null,null,null,null,null,null,null,null,null,null,"第６条","　甲は、合併処理浄化槽設置整備事業実施要項（平成６年１０月"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"２０日付衛浄第６５号厚生省生活衛生局水道環境部長通知別紙）"]
["発注者　　　　　 　　　 　　　　",{"$f":"'交付申請書 (2)'!P21","v":0},"（以下「甲」という。）及び浄化槽",null,null,null,null,null,null,null,null,null,null,"第３の(5)のアの規定に基づく検査の結果､改善を要すると指摘を"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"受けた場合は、乙に対し相当の期限を定めてその瑕疵の修補を請"]
["工事業者　　　　　　　　　　　　　　　　 ",{"$f":"'交付申請書 (2)'!O55","v":0},null,"（以下「乙」という。）は、",null,null,null,null,null,null,null,null,null,"求することができる。"]
["岡山市合併処理浄化槽設置整備事業補助金（以下「補助金」という。） ",null,null,null,null,null,null,null,null,null,null,null,2,"　甲は、法第７条の規定による、水質に関する検査を受け、その"]
["の交付をうけて甲が行う合併処理浄化槽の設置工事に関し、その適正な",null,null,null,null,null,null,null,null,null,null,null,null,"検査の結果、浄化槽の設置について、改善を要すると指摘を受け"]
["施工を確保するため、以下の条項により覚書を締結し、甲と乙は信義を",null,null,null,null,null,null,null,null,null,null,null,null,"た場合は、乙に対して相当の期限を定めてその瑕疵の修補を請求"]
["守り誠実にこれを履行する。",null,null,null,null,null,null,null,null,null,null,null,null,"することができる。"]
[null,null,null,null,null,null,null,null,null,null,null,null,3,"　前項に定める請求は、浄化槽の工事についての改善の指摘が甲"]
["第１条","　この覚書は、次に掲げる工事に適用する。",null,null,null,null,null,null,null,null,null,null,null,"の責に帰すべき事由に基づくものである場合には、することがで"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"きない。"]
["　 （１）工事の場所        ",null,"岡山市",null,null,null,null,null,null,null,null,null,"第７条","　乙は、甲から前条の規定により瑕疵の修補を求められた場合は"]
[null,null,{"$f":"'交付申請書 (2)'!R35","v":0},null,null,null,null,null,null,null,null,null,null,"すみやかに行わなければならない。"]
["　 （２）工事の予定期間",null,"交付決定日以降","～令和",null,{"$f":"'交付申請書 (2)'!AM53","v":0},"年",{"$f":"'交付申請書 (2)'!AR53","v":0},"月",{"$f":"'交付申請書 (2)'!AW53","v":0},"日",null,"第８条","　この覚書に定めのない事項については、必要に応じて甲乙協議"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"のうえ定めるものとする。"]
["　 （３）設置する浄化槽",null,"メーカー",{"$f":"'交付申請書 (2)'!R37","v":0},null,null,null,null,null,null,null,null,"   以上覚書の証として、本書２通を作成し、当事者記名押印の上各自１"]
[null,null,null,null,null,null,null,null,null,null,null,null,"   通を保有する。"]
[null,null,"機種",{"$f":"'交付申請書 (2)'!Q39","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和　　　年　　　月　　　日"]
[null,null,"人槽",{"$f":"'交付申請書 (2)'!AD37","v":0},null,null,null,null,null,"人槽",null,null,null,"                                                                                                                                   "]
["第２条","　乙は、補助金交付申請書に添付している図面（敷地内の給排水",null,null,null,null,null,null,null,null,null,null,null,"甲　発注者　","住 所"]
[null,"配管図、浄化槽配置図、浄化槽構造図等）及び仕様書に基づき、",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'交付申請書 (2)'!P17","v":0}]
[null,"前条の期間内に工事を完成し、所定の検査を行ったうえで目的物",null,null,null,null,null,null,null,null,null,null,null,null,"氏 名"]
[null,"を甲に引き渡すものとする。   ",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'交付申請書 (2)'!P21","v":0},null,"印"]
["第３条","　乙は、この覚書に係る工事を浄化槽法（以下 「法」 という。）",null,null,null,null,null,null,null,null,null,null,null,"乙　浄化槽工事業者","住 所"]
[null,"第２９条第３項に従い浄化槽設備士に実地を監督させ、又は自ら "]
[null,"浄化槽設備士の資格を有して、工事を実地に監督しなければなら",null,null,null,null,null,null,null,null,null,null,null,null,"氏 名"]
[null,"ない。",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'交付申請書 (2)'!O55","v":0},null,"印"]
["第４条","　乙は、法第４条第３項の規定による浄化槽工事の技術上の基準    "]
[null,"にしたがって工事を行わなければならない。",null,null,null,null,null,null,null,null,null,null,null,"　（登録番号又は届出番号： ",{"$f":"'交付申請書 (2)'!AR55","v":0},null,"）"]
["第５条","　乙は、岡山市合併処理浄化槽設置整備事業補助金交付要綱に定  "]
[null,"める所定の書類及び写真を所定の期間内に甲に提出しなければな",null,null,null,null,null,null,null,null,null,null,null,"　（浄化槽設備士　氏名",{"$f":"'交付申請書 (2)'!O56","v":0},null,"）"]
[null,"らない。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"備考　記名押印に代えて、署名することができる。"]

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[null,"様式第４号（第８条関係）"]
[]
[]
[null,"変　更　等　承　認　申　請　書"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"令和 　 　　　年　　　　月　　　　日"]
[]
[null,"岡　山　市　長    様"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"補助事業者",null,null,"住　所",null,{"$f":"'交付申請書 (2)'!P17","v":0}]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,{"$f":"'交付申請書 (2)'!P21:AQ21","v":0}]
[]
["令和",null,null,null,"年",null,null,"月",null,null,"日","付け岡環保浄第",null,null,null,null,null,null,"号で"]
[]
["補助金交付決定の通知を受けた補助事業について、変更等したいので、岡山市合併処理"]
[]
["浄化槽設置整備事業補助金交付要綱第８条第１項の規定により、下記のとおり申請します。"]
[]
[]
[null,"記"]
[]
[null,1,"変更等の内容"]
[]
[null,null,"（１）補助金申請内容の変更"]
[null,null,"　ア　変更する内容"]
[null,null,"　イ　変更前"]
[null,null,"　ウ　変更後"]
[null,null,"（２）補助事業の中止"]
[]
[null,null,"（３）補助事業の廃止"]
[]
[null,2,"理由"]

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["様式第５号（第９条関係）"]
[]
["実　　績　　報　　告　　書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,"年",null,"月",null,"日"]
[]
["岡　山　市　長   様"]
[]
[null,null,null,null,null,null,null,"補助事業者",null,null,"住　 所"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"氏　 名",null,{"$f":"'交付申請書 (2)'!P21","v":0}]
[]
[]
["令和",null,null,null,"年",null,"月",null,null,"日","付け岡環保浄第",null,null,null,null,null,null,"号で"]
[]
["補助金交付決定の通知を受けた補助事業については、下記のとおり完了したので、"]
[]
["岡山市合併処理浄化槽設置整備事業補助金交付要綱第９条の規定により報告します。"]
[]
["記"]
[]
[null,"設置場所",null,null,null,"岡山市",null,{"$f":"'交付申請書 (2)'!R35","v":0}]
[null,"浄化槽機種",null,null,{"$f":"'交付申請書 (2)'!Q39","v":0},null,null,null,null,null,"人槽",null,null,{"$f":"'交付申請書 (2)'!AD37","v":0}]
[null,"製造番号",null,null,null,null,null,null,null,null,"ブロワー型式"]
[null,"補助金交付決定額",null,null,null,null,null,null,null,null,null,"金",null,null,null,null,null,null,"円"]
[null,"事業完了年月日",null,null,null,null,null,null,null,null,null,"令和",null,null,"年",null,"月",null,"日"]
[null,null,"工事内容については別添チェックリストのとおり"]
[null,"維持管理体制"]
[null,null,"補助金申請時に添付した浄化槽維持管理及び水質検査契約書のとおり"]
[null,"収支決算及び実績額"]
[null,"収　入　の　部",null,null,null,null,null,null,null,null," 支　出　の　部"]
[null,"市補助金",null,null,null,{"$f":"M26","v":0},null,null,null,"円","本体価格",null,null,null,null,null,null,null,"円"]
[null,"浄化槽設置分",null,null,null,null,null,null,null,"円","埋設工事費",null,null,null,null,null,null,null,"円"]
[null,"※1　配管工事分",null,null,null,null,null,null,null,"円","※1　配管工事費",null,null,null,null,null,null,null,"円"]
[null,"※2　撤去工事分",null,null,null,null,null,null,null,"円","※2　撤去工事費",null,null,null,null,null,null,null,"円"]
[null,"自己資金",null,null,null,null,null,null,null,"円","消費税",null,null,null,null,null,null,null,"円"]
[null,"計",null,null,null,{"$f":"IFERROR(F33+F37,\"\")","v":0},null,null,null,"円","計",null,null,null,null,{"$f":"SUM(P33:R37)","v":0},null,null,"円"]
[]
[null,"※1　単独転換又は汲取り転換に伴う宅内配管工事補助を申請する場合は記入してください。"]
[null,"※2　単独転換又は汲取り転換に伴う浄化槽又は便槽撤去工事補助を申請する場合は記入してください。"]

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["実　績　報　告　審　査　票"]
[]
["提出書類・写真を確認の上、太線の中を記入し提出してください。"]
[]
["交付決定\n番　　号",null,null,"補助事業者氏名",null,null,null,null,{"$f":"'交付申請書 (2)'!P19","v":0}]
[null,null,null,null,null,null,null,null,{"$f":"'交付申請書 (2)'!P21","v":0}]
[{"$f":"'実績報告書 (2)'!Q15","v":0},null,null,"設  置  場  所",null,null,null,null,"岡山市",null,null,{"$f":"'交付申請書 (2)'!R35","v":0}]
[]
["申請手続",null,null,{"$f":"'交付申請書 (2)'!AD31","v":0},null,null,null,null,null,null,null,"担当者",null,null,null,null,null,"TEL"]
[]
["提　出　書　類",null,null,null,null,null,null,"ﾁｪｯｸ",null,null,null,null,null,null,null,null,"口座振込依頼書及び通帳の写しを添付"]
["実績報告書"]
[]
["変更届出書",null,null,null,null,null,null,null,null,null,null,null,null,null,"ゆうちょ銀行以外の金融機関（通帳の写しを添付）"]
["(住民票)"]
["完工図面",null,null,null,null,null,null,null,null,null,null,null,null,null,"金融機関名"]
["保証登録証"]
["請求書又は領収書の写し",null,null,null,null,null,null,null,null,null,null,null,null,null,"支店名"]
["チェックリスト"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口座種別",null,null,"■普通",null,null,null,null,null,null,null,null,"・",null,null,"□当座"]
["その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口座番号"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ゆうちょ銀行（通帳の写しを添付）"]
[]
["補助金交付請求書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記号"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番号"]
[]
[null,null,"日付",null,null,"指　　　摘　　　事　　　項",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担　当"]
["受 付",null,"／"]
["入 力",null,"／"]
["係 員",null,"／"]
[null,null,"／"]
["室 長",null,"／"]
["連 絡",null,"／"]

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[null,"（第８条関係）"]
[]
[null,null,"課　　長",null,"課 長 代 理",null,null,"課長補佐",null,"主　　任",null,"課　　　　員",null,null,"担当者"]
[]
[]
[]
[null,null,"変　更　届　出　書"]
[]
[null,null,null,null,null,null,null,null,null,"令和",{"$f":"'実績報告書 (2)'!M5","v":0},null,"年",{"$f":"'実績報告書 (2)'!P5","v":0},"月",{"$f":"'実績報告書 (2)'!R5","v":0},"日"]
[]
[null,"　岡　山　市　長　様"]
[]
[]
[null,null,null,null,null,null,null,"　補助事業者",null,null,"住　所",null,{"$f":"'実績報告書 (2)'!M9","v":0}]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"氏　名",null,{"$f":"'交付申請書 (2)'!P21","v":0}]
[]
[]
[null,"　補助申請内容に変更があったので、次のとおり届出ます。"]
[]
[null,"変　更　内　容",null,null,null,"変　更　前",null,null,null,"変　更　後",null,null,null,"変 更 年 月 日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,"年"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"月",null,"日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,"年"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"月",null,"日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,"年"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"月",null,"日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,"年"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"月",null,"日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,"年"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"月",null,"日"]

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["補助事業者氏名",null,{"$f":"'交付申請書 (2)'!P21","v":0},"浄化槽設備士氏名"]
["設置場所",null,{"$f":"'交付申請書 (2)'!R35","v":0},"免状(修了)番号"]
["写真NO.","工程","チ　ェ　ッ　ク　ポ　イ　ン　ト"]
[null,"着工前写真","浄化槽設備士、標識板、工事看板及び埋設予定場所全体が、周囲の状況とともに写っているか。また、宅内配管工事費用及び便槽撤去工事費用を申請する場合は、工事看板及び水廻りを有する建物の外周とその付近の地面についても写っているか。"]
[null,{"$f":"'実績報告書 (2)'!F15&\"月\"&'実績報告書 (2)'!H15&\"日\"","v":"月日"},"工事看板の設置場所・補助事業者名・交付決定日及び交付決定番号に誤りはないか。"]
[null,{"$f":"'実績報告書 (2)'!Q15","v":0},"浄化槽設備士は、ヘルメットをかぶり、正面を向いて、人物が特定できるか。"]
[null,"床掘り","全体を平坦に均した状態であるか。"]
[null,"栗石・砕石敷き","栗石又は砕石が全体に均一に敷かれ、10cm以上の厚みはあるか。",null,"厚み　　　　　㎝（≧10cm）　"]
[null,"配筋・　　　　　　　コンクリート打設","底版コンクリート２次製品を使用する場合、対応機種に合ったものが使用されているか。\n底版コンクリート２次製品を使用しない場合、コンクリートが全体に均一に打設され、底面全体の状況および厚み(≧15cm）、配筋の間隔(≦20cm)および硬化状況は十分か。"]
[null,"吊り込み","埋設される浄化槽の機種に相違はないか。",null,{"$f":"'交付申請書 (2)'!Q39","v":0}]
[null,"水張り・　　　　　　水平確認","埋め戻し前か。"]
[null,null,"水張りをしながら、長辺方向及び短辺方向の水平確認を行っているか。"]
[null,null,"漏水生じていないか。"]
[null,"埋戻し・水締め","水平が保たれているか。"]
[null,"転圧・埋戻完了","埋戻しが終了した後、全体を十分突き固めているか。"]
[null,"上部スラブ配筋","配筋はマンホールの強度を十分考慮し、補強が的確に行われているか。"]
[null,"工事完了写真","浄化槽設備士が完了を確認していることが分かるよう、浄化槽設備士とともに着工前写真と同じ方向から、埋設場所全体が分かるように撮影されているか。"]
[null,"かさ上げ","コンクリートスラブが打たれ、マンホール枠の上端まで固定されているか（粗打ちの場合は仕上げ工事完了まで安全面に留意することを確認したか。）。"]
[null,null,"バルブの操作などの維持管理を容易に行うことができるか。",null,"高さ　　　　　ｃｍ（≦30cm）"]
[null,"浄化槽稼働","嫌気ろ床槽のろ材及び接触ばっ気槽の接触材に変形や破損はないか。しっかり固定されているか。"]
[null,null,"ばっ気装置、逆流装置及び汚泥移送装置の変形や破損はないか。しっかり固定されているか。"]
[null,null,"空気の出方や水流に片寄りはないか。"]
[null,null,"消毒設備に変形や破損はないか。しっかり固定されているか。"]
[null,null,"薬剤筒は傾いていないか。"]
[null,"製造番号","保守点検、清掃を行いにくい場所に設置されていないか。"]
[null,{"$f":"'実績報告書 (2)'!E25","v":0},"保守点検、清掃の支障となるものが置かれていないか。"]
[null,"ブロワー　　　　　　　設置状況","防振対策がされているか。"]
[null,null,"固定が十分行われているか。"]
[null,"型式","アースが必要な機種か確認し、必要な場合は接続されているか。"]
[null,{"$f":"'実績報告書 (2)'!N25","v":0},"漏電のおそれはないか。"]
[null,"ポンプ槽","上部コンクリートスラブが打たれ、フロートスイッチのケーブルが絡むことのないよう設置されているか。"]
[null,null,"ポンプますに変形や破損はないか。"]
[null,null,"ポンプますに漏水のおそれはないか。"]
[null,null,"設計どおりの台数及び能力のポンプが設置されているか。"]
[null,null,"ポンプの固定が十分行われているか。"]
[null,null,"ポンプの取りはずしが可能か。"]
[null,null,"ポンプ位置や配管がレベルスイッチの稼働を妨げるおそれはないか。"]
[null,"放流先","申請時又は変更等承認申請時と同じ公共の放流先か。"]
[null,null,"放流口と放流先の水路等の水位差が適切に保たれ、逆流のおそれはないか。"]
[null,"台所専用升      ※クリーン升は内径のみ記入。別途仕様書提出のこと（旧御津町のみ）","台所排水専用となっているか。"]
[null,null,"油止め構造になっているか。"]
[null,null,"内径　　　　　　　cm(≧30cm)　　・　　水深　　　　　　　cm(≧25cm)　　・　　継足　　　　　　　cm(≧15cm)"]
[null,null,"内径　　　　　　　cm(≧30cm)　　・　　水深　　　　　　　cm(≧25cm)　　・　　継足　　　　　　　cm(≧15cm)"]
[null,"配管経路・各桝","汚物や汚水の停滞がないか。"]
[null,null,"生活排水が全て接続されているか。"]
[null,null,"雨水や工場排水等が流入していないか。"]
[null,null,"起点、屈曲点、合流点及び一定間隔ごとに適切な升が設置されているか。"]
[null,null,"流入管きょ、放流管きょ及び空気配管の露出等により変形、破損のおそれはないか。"]
[null,"撤去写真","撤去予定のものが全て撮影されているか。"]

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[null,"様式第７号（第１１条関係）"]
[]
[]
[null,"補　助　金　交　付　請　求　書"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"令和 　 　　　年　　　　月　　　　日"]
[]
[]
[null,"岡　山　市　長    様"]
[]
[]
[null,null,null,null,null,"補助事業者",null,null,"住　所　",null,null,{"$f":"'実績報告書 (2)'!M9","v":0}]
[]
[]
[null,null,null,null,null,null,null,null,"氏　名　　　",null,null,{"$f":"'交付申請書 (2)'!P21","v":0}]
[]
[]
[]
[null,"　令和　　 　年　　 　月　　 　日付け岡環保浄第　　 　　　　　　号で補助金交付額の確定通知のあった"]
[]
[null,"岡山市合併処理浄化槽設置整備事業補助金の支払いを受けたいので、岡山市合併処理浄化槽"]
[]
[null,"設置整備事業補助金交付要綱第１１条の規定により下記のとおり請求します。"]
[]
[]
[]
[null,"記"]
[]
[null,null,null,"請  求  金  額",null,null,"金",{"$f":"'実績報告書 (2)'!M26","v":0},null,null,null,"円"]

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[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"口座振込依頼書"]
[null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[]
[null,null,null,"岡 山 市 長   様"]
[]
[null,null,"合併処理浄化槽設置整備事業補助金を下記口座に振込むよう依頼します。"]
[]
[]
[null,"補助金申請者\n\n(口座名義人)",null,null,null,null,null,null,null,null,null,null,"フリガナ",null,null,null,null,null,null,null,null,{"$f":"'交付申請書 (2)'!P19","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,{"$f":"'交付申請書 (2)'!P21","v":0}]
[]
[]
[null,"連絡先",null,null,null,null,null,null,null,null,null,null,"〒"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"住　所",null,null,null,null,{"$f":"'実績報告書 (2)'!M9","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"ＴＥＬ",null,null,null,null,{"$f":"'交付申請書 (2)'!T23","v":0}]
[]
[]
[null,"　※補助金申請者の口座にしか振込めません。誤ってご家族名義の口座を記入しない\n　　ように注意してください。なお、銀行印や認印の押印は不要です。"]
[]
[]
[]
["振込先口座"]
["(ゆうちょ銀行以外の金融機関 または ゆうちょ銀行 どちらか一つの欄に記入してください)"]
[]
[null,"ゆうちょ銀行\n\n以 外 の\n\n 金 融 機 関"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"銀行\n\n金庫\n\n農協\n\n信組"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"店"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"所"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"口座種別",null,null,null,null,null,null,"普　通　　当　座",null,null,null,null,null,null,null,null,null,null,null,null,"口座番号"]
[]
[null,null,"ゆうちょ銀行",null,null,null,null,null,null,null,null,null,null,"記　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番　　号"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（５桁）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（最大８桁）\n右づめでご記入ください。"]
[]
[]
[null,null,null,"※記号と番号の間に数字が入っている場合、「その数字」は記入しないでください。\n　　　　　　　\n例　〇〇〇〇〇－１－△△△△△△△△　　　　　"]