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FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAlL
SOUTHOLD, N.Y.
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BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
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23141 Z
Date ............../p.9................................ 19..?.~
Permission Is hereby granted to:
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to ........... ....;.!/,,7L.4.cr............. .dtY.............dM';.~':1{b)........ .... {.P.. ..... ..P1..... .~UH.
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..................................................................."...",................".....",.............................................................
........... ........................ ........ ..... ..Jif: Eg,g.X.((:-Y...... .77:~~k.. .............................................. ...
at premises located at........!';['(~!,?<i~.. .~..&i.....;;4:.............................. ...................
................................................~Ma~".................................................
County Tax Map No. 1 000 Sec~on ..../0./............. Block ...../................ Lot No. .~q....................
pursuant to application dated...... .A t(:....... .?..~..................... 19.. ..9.,:;:;=. and approved by the
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Rev. 6/30/80