HomeMy WebLinkAbout7171-ZFO~M NO. ·
TOWN OF SOUTHOLD
BI. nI.BINC. DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No. g6[0¢ ....... Date ..........J~.. ~ ......... , 19.7.5.
THIS CERTIFIES that the building located at . .lt/~;. l/,ain..Road ........... Street
Map No..xx ........ Block No. xx ........ Lot NoJ~x.. ~uthald.. I~,Yo ...........
conforms substantially to the Application for Building Permit heretofore filed in thi.q office
April
..0 ~ l:'e .....71 '}'1Z
1.19.~.. pursuant to which Building rnu~ ao.722~..
dated ...........Iqay'" ' I' '
dated .......... A.l?.r.~i~ay..1.0.3, 19~., was issued, and conforms to all of the require-
merits of the applicable provisions of the law. The occupancy for which thl.q certificate is
issued is ~r~t.vate..one. family..dwe~.l~Jag, with. additian. &<er. at Ions. AI~.
ho,p~tal
The certificate is issued to .Dr,..14~i;[.$am. Z,$tek ..... f&~ne~ ........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .. l~.dt, .............................
UNDERWRITERS CERTIFICATE No..~ ~ ~70+9-..~/~ -1/-7~- &- '~ 1 ?~3~. -'7/~'1'/~
HOUSE NUMBER .... ~Sf>O~ .... Street .. l/~.]a. ~oa~l. · .Szu.~hold .................
....... ..... ........
....... !o~ T,~M
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