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FORM NO.3
22806 Z
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(THIS PERMIT MUST BE KEPT ON THE PREMIS~SIZUENDTI) L FULL h tjV\ L]) v--r ~
COMPLETION OF THE WORK" LJ L I
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Date ............. ............. ....~7........................ 19..9'Ff
TOWN Of SOUTHOLD
BUILDING DEPARTMENT
TOWN HAll
SOUTHOLD, N.Y.
BUILDING PERMIT
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Permission Is hereby gr~ ,fl:,
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County Tax Map No. 1 000 Sec~on ..........ZZ.. Block ............~...... Lot No. ....~...............;..
pursuant to application dated ...................~ar....?.~ 19.....$1...Gnd approved byttie
Building Inspector.
Fee $..a.$..~....
Rev. 6/30/80
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