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FORM NO.3
~OLD
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
N~
23438 Z
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ....C.?ft::?,........................................... 19.9.~.
permISSlonISherebygra:tedto: yJ~ ~ ~t8-o-l .
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County Tax Map No. 1000 Secffon "~.:Z:.......... Block ..../.................. Lot No. ....21:"./...........
pursuant to appllcaffon dated ..........i)l.e.;.~........................., 19.~......, and approved by the
Building Inspector.
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Fee $.../.U4...~
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Rev. 6/30/80