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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~ 21511 Z
Date................. .?O..................................., 19..9.i...
Permission Is hereby grant~:
.... ......~ 1:~.b....... .M.. ....... .rM:. '1.IA:~.....................
.?~.~1~~...~.~:.........tI..(2~..~$..~~
.~e.C!.~.......~;Y:.......................................
to ......Cat!$.r:.<.#..Cr..........~.......~.. ...d.q,~~y,/..~~~(;........ ..~~g:..
~r/t;/.~...... d.~.... ..~~d;d.... .Lar:C...............................................".............,.........
at premises located at................. 21:..:f:........ .d.(;~~...... )((.~.......................................
............................................................. .?ii~~C!..'!!!.r......... .~y.:.......................................
County Tax Map No. 1000 Section ........;[.?.......... Block ..........(21.......... Lot No. ....!.~.~..lf..... .
pursuant to application dated .....................~ /::..2....................., 19.... .9...$....., and approved ~y the
Building Inspector.
Fee $...J.~~.......
Rev. 6/30/80
....~..L:~i~~......................
'135- ~
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