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FORM NO. 3
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO.
25917 Z
Date AUGUST
5, 1999
Permission is hereby granted to:
MICHAEL E. & KATHRYN GAGEN
PO BOX 165
MATTITUCK,NY 11952
for :
INSTALLATION OF AN ACCESSORY ABOVE GROUND SWIMMING POOL "AS BUILT"
IN THE REQUIRED REAR YARD AREA AS APPLIED FOR.
at premises located at
4415 WESTPHALIA RD
MATTITUCK
County Tax Map No. 473889 Section 113
Block 0013
Lot No. 016
pursuant to application dated JULY
Building Inspector.
2 1999 and approved by the
Fee $
50.00
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Auth~Sign ure
ORIGINAL
Rev. 2/19/98
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING/STRAPPING ~FINAL /~
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:_~
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