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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)
N~ 22061 Z
Date ...............?j/.J............................... 19...Y.Y
Permission Is hereby granted to:
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to ..... .c~c!./4Y..<:.;:"........ .d.......... .A?/. ~a.'......... &J.!. /. ~J:-:!.........-::'!:!.......................
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at premises located at................ ......... ......... ... /.::.~...... .....:::............ .........:...............................................
.....................................................................&-?!.T./../..~~<.....(.'!(;Y........................................
County Tax Map No. 1000 Section ....//~......... Block ........c2.rR.......... Lot No. ...../2...............
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pursuant to application dated ......../..(/.:/.'::-/...................................., 19......7...f,::.. and approved by the
Building Inspector.
Fee $..2~~........
Rev. 6/30/80
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