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			<p style="text-align: justify;"><span style="font-family: ITCAvantGardePro; font-size: 12px;">&nbsp;</span><span style="font-family: ITCAvantGardePro; font-size: 12px; font-weight: 900;">Maison individuelle :</span></p>

<p>{% checkbox_tag name=&quot;4eb5edd8&quot; data_label=&quot;Assainissement collectif&quot; data_help=&quot;assainissement collectif&quot; data_ancien_ids=&quot;22975&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">assainissement collectif&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; </span>{% checkbox_tag name=&quot;7e3de320&quot; data_label=&quot;Assainissement individuel&quot; data_help=&quot;assainissement individuel&quot; data_ancien_ids=&quot;23099&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;assainissement individuel</span><br />
			{% checkbox_tag name=&quot;4bc57b64&quot; data_label=&quot;Cave&quot; data_help=&quot;Cave&quot; data_ancien_ids=&quot;22548&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">cave&nbsp; &nbsp;</span>{% checkbox_tag name=&quot;6aec8aeb&quot; data_label=&quot;Garage&quot; data_help=&quot;Garage&quot; data_ancien_ids=&quot;22646&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"> garage&nbsp; </span>{% checkbox_tag name=&quot;e1ce7206&quot; data_label=&quot;Parking&quot; data_help=&quot;Parking&quot; data_ancien_ids=&quot;22697&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;parking&nbsp; &nbsp; </span>{% checkbox_tag name=&quot;6ef7bd3a&quot; data_label=&quot;Grenier&quot; data_help=&quot;Grenier&quot; data_ancien_ids=&quot;22746&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;grenier&nbsp; &nbsp; </span>{% checkbox_tag name=&quot;2e553027&quot; data_label=&quot;Abri de jardin&quot; data_help=&quot;abri de jardin&quot; data_ancien_ids=&quot;22794&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;abri de jardin&nbsp; &nbsp; &nbsp; </span>{% checkbox_tag name=&quot;46e0e089&quot; data_label=&quot;Portail automatis&eacute;&quot; data_help=&quot;portail automatis&eacute;&quot; data_ancien_ids=&quot;22847&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;portail automatis&eacute;&nbsp; &nbsp; </span>{% checkbox_tag name=&quot;be68ad80&quot; data_label=&quot;Porte automatique de garage&quot; data_help=&quot;porte automatique de garage&quot; data_ancien_ids=&quot;22896&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;porte automatique de garage</span></p>
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			<td>{% checkbox_tag name=&quot;0933324e&quot; data_label=&quot;Piscine&quot; data_help=&quot;Piscine&quot; data_ancien_ids=&quot;22473&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; piscine (pr&eacute;ciser, le cas &eacute;ch&eacute;ant, le dispositif de s&eacute;curit&eacute;) :</span></td>
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			<td>{% textarea_tag name=&quot;39d418ba&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Dispositif de s&eacute;curit&eacute; piscine&quot; data_help=&quot;dispositif de s&eacute;curit&eacute; piscine&quot; data_ancien_ids=&quot;22412&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: middle; width: 45%;">{% checkbox_tag name=&quot;d55ce1f2&quot; data_label=&quot;Citerne gaz&quot; data_help=&quot;Citerne Gaz&quot; data_ancien_ids=&quot;22159&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">citerne de gaz d&rsquo;une contenance de (en litres) : </span></td>
			<td style="width: 55%;">{% textinput_tag name=&quot;53c50b7f&quot; data_label=&quot;Contenance citerne gaz&quot; data_help=&quot;contenance citerne gaz&quot; maxlength=&quot;50&quot; data_ancien_ids=&quot;22208&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: middle; width: 45%;">{% checkbox_tag name=&quot;aacbcecb&quot; data_label=&quot;Cuve fuel&quot; data_help=&quot;Cuve fuel&quot; data_ancien_ids=&quot;22236&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"> cuve &agrave; fuel d&rsquo;une contenance de (en litres) :</span></td>
			<td style="width: 50%;">{% textinput_tag name=&quot;4d2578ae&quot; data_label=&quot;Contenance cuve &agrave; fuel&quot; data_help=&quot;contenance cuve &agrave; fuel&quot; maxlength=&quot;50&quot; data_ancien_ids=&quot;22284&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: middle; width: 10%;">{% checkbox_tag name=&quot;3547b90f&quot; data_label=&quot;Autres &quot; data_help=&quot;Autres&quot; data_ancien_ids=&quot;16755&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"> autres :</span></td>
			<td style="width: 90%;">{% textinput_tag name=&quot;36f830c2&quot; data_label=&quot;Autres&quot; data_help=&quot;Autres &quot; maxlength=&quot;80&quot; data_ancien_ids=&quot;22129&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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