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Home My WebLink About6265-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificste Of Occupsncy No..~, ..... Date ........... I~OV,'" ~8 ...... , 19'72 THIS CERTIFIES that the building located at Map No..~,~ ........ Block No...~ ...... Lot No .... ~-'- conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~t' 8 19 ~. pursuant to which Building Permit No60~, dated ........ .A~-. ~ ....... , 19.~1~., was issued, and conforms to all of the require- ments of the applicable provisions ~of the law. The occupancy for which this certificate is issued is '. Pld-v&i;e .on~. i~&ml.].~· 'dw~'ling' ' ' ~ 'a~O~'~tol~y 'd®~k ............... The certificate is issued to -llall. ~ot;g~&v~ .... O~aol, ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ]~tl, ........................... UNDERWRITERS CERTIFICATE No. -][*1~* ........................................... HOUSE NUMBER... ~.~ ...... Street...]~'~..VI~,~.