The URL can be used to link to this page

Home My WebLink About33387-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32605 Date: 09/17/07 THIS CERTIFIES that the building ACCESSORY BARN Location of Property: 175 PRIVATE (HOUSE NO.) County Tax Map No. 473889 Section 59 RD #26 (STREET) Block ~ SOUTHOLD (HAMLET) Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 13, 2007 pursuant to which Building Permit No. 33387-Z dated SEPTEMBER 13, 2007 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY HORSE BARN IN THE REQUIRED REAR YARD AS APPLIED FOR. The certificate is issued to HENRY R & CAROL A. JACOBI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ~ed~ Rev. 1/81 :\':lur~'1 ~ '~"Jr~I'-ln \~ k 1,:;[::)'\ TOWN~;~~U~HOLD , v BUILDING DEPARTMENT L TOWN HALL ___~...J 765-1802 I l.H....L' , (v L--J~~~:.QrSC'~ITH.9'L_APPLICATION FOR CERTIFICATE OF OCCUPANCY ." _,.n 7f'bO O. n - 'QYVO-^-L ""'~~.L ~\71r 11~7( This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I, Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features, 2, Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form), 3, Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I % lead, 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6, Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings aud "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features, 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied; the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy, New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25,00, Accessory building $25.00, Additions to accessory building $25,00, Businesses $50.00, 2. Certificate of Occupancy on Pre-existing Building - $100.00 3, Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy, $50.00 5. Temporary Certificate OfOccllpancy, Residential $15.00, Commercial $15,00 New Construction: Date, / Old or Pre-existing Building: /1)> .. f?z/t//tl- eJ House No, Street ownerorownersofProperty:~AY~ 'f- C'AI-t#?_V,KJ relk, Suffolk County Tax Map No 1000, Section -.5 9 Block 9 ( check one) S6J~1p Hamlet Location of Property: Lot g Subdivision -- Perrnit No -'1338'? .:z.._ Date of Penn it. 9- /7 -d '7 Applicant: /k-i</7 t211lCL:lJ." Health Oept. Approval: _._.... ~____ __ Underwnters Approval Filed Map. Lot. ~;( Planning Board Approval: __ Request for: Temporary Certificate ___., Final Certificate: tf'7j (check one) Fee Submitted: $ <9-<<.. T'? 0 ? I Co <e~~(}5 FORM NO. 3 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) PERMIT NO. 33387 Z Date SEPTEMBER 13, 2007 permission is hereby granted to: HENRY R SR & CAROL JACOBI 7980 SOUNDVIEW AVE SOUTHOLD,NY 11971 for : CONSTRUCT AN ACCESSORY HORSE BARN AS APPLIED FOR. THIS PERMIT REPLACES BP 18895. at premises located at 175 PRIVATE RD #26 SOUTHOLD County Tax Map No. 473889 Section 059 Block 0009 Lot No. 003 pursuant to application dated SEPTEMBER 13, 2007 and approved by the Building Inspector to expire on MARCH Fee $ 100.00 Rev. 5/8/02 ORIGINAL 333&"7 ~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUC11ON REMARKS: [ ] ROUGH PLBG. [ ] INSULATION I)<lFINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION " ~~~}D DATE 9-/7-- 07 INSPECTOR ~~ F. UP ItilSf'a.notJ IP4TIE CO'!' TS 1: I il . '.'it.:.U .,,\ 1 . '. I ~\ I -, " ::::;. ::-OUllOA TIO~I -.i.' s!.l - ...."1 - -- - , c: " C/l F"OU/IDA TIO:! (2nd) .. 2. iz I a . ROUGH F"RAi'IE & ,PLUHBING .. .. . C/l ~ 3. :::l '" '" IlISULATION PER N. Y. " ~ - STATS ElIERGY COOE I " -?/. ~ " ::: 0' ,. Pl..- . '... 'J l' .~~V/7~ :;:: Cf~J"2 07 A "" 4 . Alo 'p A.. A, fPt: 'ZI - ~ , e:- " .1 .., - FI:IAL - I .. " ADDITIONAL C0!1MEIITS: '", '" .. " .. " .. ,. 0 . ' . - . '" ~,: " H '" . ". ~ H a - " . 1 - . - '" ". c- o .. .; ::: . '" '" ." .; .. :(;1 . .. . . Jili' ... \J-l ~ ~ " ~ t ~ ~ " ~ ~ ~.. {' uJ ~~ ~"', ""- NV,t S . :.(-".1 . . , , I ce,( ,,"'J> " .i t'. LAND ~,< IMP. TOTAL FARM DATE COMM. CB. REMARKS Mkt. Value '(':.,1 , dli1.~ 6--:A- ,-' VL . '~ /,' l':' - " i ~+._.':--~--;,'t..~:1\ '. J i} ,....... "~-""...,..r;' 'fie'~'}''; .,' ~/~_....;..._:.-;,.f t.'; !r,t ....... ,..., ,4 / ()-e1 :t 0 II j,;"$'01> 1k<; , ~,"""#6' Slu.'" ' ~11'~,$"'.. . .L -.', .... , . ~~i E "NEW: FARM. .,' '!".: Tillable L Tlllabl~,', 2. Tillable '3,'; Wooclland~ir.,' Swampland" " ".;~'c"~:."'<'" BULKHEAD .~,....""t:"""~l; '?- , ,>:. i'?>>.;'i~' ~;1:i'f~.'~ ';;;l~iJi~~~ I)oc ;~, c' ,t( ,:.,..~..,~~\~.;.i>'j..~l&;:;i~\~-9~(;::.r";>_~'.~":~\i,4,.~:.~~t}'~;'L\'~;'J:.;:: FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH " , "';" ,~,lf., :_ , ,,,;, ., M. Bldg. :xtension :.~ If<u OA.enslon", ,. Extension --...,... .~ \ p '-i$ COLOR _.'1 '-", " ~ ... .- ;= ~ ~~-=--- 'REb TRIM " .f" 1f;, . , -4- IJ.Ilx"~,:p-stJf)' /::" 1t9.'""Y.Y~~" 3 ~I /1./0 , /,s~A"J" .. 300 ~(" I .... .) Foundation . ~ </.:)"/ ~asement 9 7_(""1 Ext. Walls A /1/ 3J5 / Fire Place lor IT ype Roof /L ~ecreation Room 'orch J)_ _ ~ 'J~K ~ 1- & 3.l Ii 'md1 ' Breezeway Sa~(e'1~s Patio ." , Dormer ,.- / Drivewoy /~x,;lc/': oI/Jz. sv- It.)...' I c,R. c'~J4wJ. -, . AS.~__ 'II ,~ " /, ! " - .'fbf~+il f ~ .;' "" . ~ . ,. ." ,,) ,:t"'I_ , If" > 1,( V( ': . [;1.; - ~ . . .- \ ~"",,~ fI , }II" I ~ '-~ , , . I. 'f-, .1. .,... . > k'!: ." "l /L, " .' . , I,~ Both / Dinette Floors 5//8. K. 5HEETRDC.k. LR. l--., \ DR. Interior Finish Heat €/..Fc.. Rooms 1 st Floor BR. . FIN. B. Rooms 2nd Floor O. B. 11 t P L J. ~-:; ~ ~ol -', ' 6/ ~.'~ 7 . _~':'___'1>~~I" ) II"" -. .' ''i<;:~''Z'_~--~:_,Bt'lfhl~i-Q-",''';0~~:'Wi~-D\t~''"~:~~;i;~~";~jL~. ,_'">-c---.___ ,; <! " '_~.,' -/ ,,,- ,w ~. ..~~ '. .1;i,'..' ;"'~'i'i..,,:-:,..\,.".- ,.1--,::'~:<i;(.[,' ,'".", '",'..:'.-. I ." .~>..'<'L..:.~...", " -' -.;-,. ,!I'lI"_.. , ,,,~7i~ ';_' \.' . t~:;~;.(',,::' i:ij.,:.'.' yo, >,,'.~;}_:<i .',;,,4>);' ',"':1.:/,', "i ',", <r""F'~t;' , .". ,.;,. \.:,'" .:~I;'.:'~';}t,!,/"_';S~:~#I~~:~~'ry?c;,':'~pj.:-~. ~';~-:~/A~:':';'i'i;;,~t~~:~<;-::;I",J~~'~.;.~:' . -.. +. ,~~ I' C - j:'~ .~ (;;'Yf ;<~f.'i ""_:;..~ -;.t ~~ .'~ '.~I : L ',0.\. ii, ",\, ,1 \j ,,j "':~: :,'L "::' .... ;-;,E'", '': i}')\ ':~':i:~i] ';!;';U .- - ~:i - "j.,'k ,"'-':4'~~Ur'ii, '/,'i / ..:'~' ."t')r,:.~t ':,\:~~';'~ , ~,. ~, '..' .; ;t~i;';'1:r'J':;~~';;1:('" .. ''"''Y'-~' '''~;, Yi-:-$-i"',-, '" ,; e- _ ,.'-'\ ; '~~"'i"UY;' , ,.,,'. ,--, ;~r~'0\~~:':~':j~!1t:':~'1}-~:\,'\ ,~. BOARD OF HEALTH :;...:--'........ 3 SETS ~PLANS ............ SURVEY V"I.04:5".......... CHECK ...... I..... .... ..... . SEPTIC FORN ................ FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL.: 765.1802 Examined~~.~.". '" 19.9.'~ ~ j~3y;'J Approved.. .o?/~......., 19 r.<?Permit No. /~ NO~1~i : ... ?!1e>:-. ~ !l.l.~ . . . ?:.f.: NAIL TO: _ .. .7.Cp~'7.~? 7~f........ ..................... . Disapproved alc ................ ..................... [F.-- liD [g I . I 91911) r2 DI'JTli. ;'j l.5 \;;!,,~,;;;,-". ......................................~......& ~~..~4..~. (B~ing~dtor) APPLICATION FOR BUILDING PERMIT "i Ij '8 BLDG. DEPT. TOWN OF SOUTHOLD Date . (~/!!1~P!..... . ., 1!f.J.~ INSTRUCTIONS A ~ - a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ,shall be kept on the premises available for inspection thrOUghout the work. e. No building shall be occupied or used in whole or in part for a':lY purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold. Suffolk County, New York, and other applicable Laws, Ordinances or Re~ulations, for the construction of buildings, additions or alterations. or for removal or demolition. as herein described. The applicant agrees to comply with all applicable laws. ordinances, building code, housim; code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~7 L? tJ . . . &~~~~. ~.~"........ . (Si.~nature 01 apDlica or-.name, if a corporation) Mrs. ~drol Anne ~aco 1, Sr. P.O. Box 165, Southald, NY 11971 ................. ............................. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OWNER . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N f f Henry Robert AND Carol Anns Jacobi, Sr. ame 0 owner 0 premises .......................................................................... ' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. N/A .............................................. (Name and title of Corporate officer) Builder's License No. .tl~I!(:.-I.$............... Plumber's License No. ........................ Electrician's License No. ...................... Other Trade 's License No. ...............;..... I. location of land on which proposed work will be done; 175 Private Road 26, Southold, NY 11971 (Previous de~ignationl' 7980 Soundvlaw Ava ....................................... ............................................ House Number . Street. Hamlet . ..... . . .. C '. 5 9' ... - 9 _ 3 ; ounty Tax Map No. 1000 SectIon .................. Block .................. lot................,... Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Riled Map No. .............. lot................ (Name) ::!. State existing use and occupancy of premises and intended lIse and OCCllpancy of proposed construction: a. Existing use and occupancy b. Intended u se and OCCupancy Private Residence .~~~:~~.:.::.:~~~~.~~~~~.~~:~.......~~...... .......... ..... ....... P......................... ............ ;;..et........ . .~, 3. N~ture of work (check whicn ~pplic~ble): New Building .. H. . . . .. Addition.. . . . . . . .. Alter~tion ......... R ' . R' I D I't' SW1'mml'na 001 ep:ur '............. I!mov~ .....,........ emo I Ion .............. c P . . .'. . . . .. . . .. Tennis Court ......... Accessory Building. . . . . . . . . . Fence ...... .Other Work, . . . . . . . . . . . 4. Estimated Cost..... ~h~~~:~~........................ Fee.................................... . . . (One Thou3and, Eight Hundred Dollars) (to be p~id on filing this ~pplic~tion) S. If dwelling, number of dwelling units .~;>. .. . ...... ., Number of dwelling units on e~ch floor .N!f.... . '..... " . . If g~rage. number of c~rs .......... ~,~. ........ .. .. . . . . . . .., . . . ... . . .... . .... . .................. . . 6. If business. commerci~1 or mixed occup~ncy, specify n~ture ~nd cxtcnt of e~ch type of use .... . tV f.. . . . . . . . . . . . 7. Dimensions of existing structures, if ~ny: Front. . , .QQ !!;;, 11.~'~ . . Re~r . ." . . . . . . . . . .. Depth.. ~~.'. . . . . . . .. . . Height ............... Number of Stories. ; . ~~"?~~:~"?';'~': . ~ .~-:s.t.o.r.Y. .G.a.r.a.3.e!.B.e.d!,?o~. .(~:,p.l;,;<. :'~r::'!.. . . Dimensions of same structure with ~Itcr~tions or additions: Front .. .N/.A. . . . . . . . . . .. Rear................. . . Dcpth . . . . . . . . . . . . . . . . . . . . . . Height. . . . . . . 'I' . . . . . . . . . . . '. Number of Stories. . . . . . . . . . . . . . . . . . . . . . : 8. Dimensions of entire new construction: Front. . . . . .-1~ . '!~~" .. Rear............... Depth 3'1~. :-?r'~. . . . .. . . .laUi ~ QAlI 1 Height .. L.IflIl:i.";, .'0 ....... . Number of Stories. . . . . . . . . . . . . . ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size oflot: Front .....: ~~: ... . .. .. .. ... Rear.... ~ ~~: .. .. .. .. . .. ... Depth ..2~~.'................. . 10. Date of Purchase . /'oPPf9". )il'~L Eli'': .L,'l'~9........ Name of Fonner Owner.. :l.u.lf'. ;1:f'JI1!"fPi'I<.i. J}.f1[1flJ..... . . II Z u d' t ' t' h' I . 'd Re-idential . one or se IS nc III w IC 1 premises are situate ...... =: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 12. Does proposed consJJnuc~ion violate any zoning law. ,ordinance or regulation: tl.o........................... ~ 13. Will lot be regraded ~.f!lft.lt f;j, f>~.A11;,,!.8.'~J<. . . . . . . . . Will excess fill be removed from premises: , Yes..~. 14. Name of Owner ofpremisls ':i~.~:t.~. C?~r:'?~ .-!'!i?'lt?~ Mdress 17:~ .P.r. .R.d. .2.6.,. .s?u.t.h?~lioHeNo.5~fiJ. ?fi;;;;;;;. .. .' Name of Architect .............. . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. .............. .. Name of Contractor ...... ...........;........ Address...... ... ..... ..... Phone No. .... ".. ....;. . ., 15.Is this property located within 100 feet of a tidal wetland? *YES....NO.~~. *If yes. Southold Town Trustees Permit may be required. PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether . interior or comer lot. . .. Property & ~uilding Diagram ~urvey attached. STATE OF NEW YORK, COUNTY OF . . ~~rr?~~. . . . . . .. S.S I1'l'':<;?! .I~~~~ .-!'l'99i:?i., .~r;... . . .. ... . .. . . .., . . . . .. . .. ,. being duly sworn, deposes and says th:!t he is the applicant (Name of individual signing contract) above named. He is the. . . . 9~~~': . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... (Contractor, agent, corporate officer, etc.) of s:!id owner or owners, and is duly authorized to perform or have performed the said work :!nd to make and file this . ' applic:!tion; th:!t all statements contalllcd in this appliqtion are true to the best of his knowledge and belief; and th:!t the work will be perfonned in the mmner set forth in the application filed therewith. . Sworn to before me this . . u IC, ... ... .................... ...... ounty ~4d/' ~~ ~ -~ ~l ............... '~(;;' . ;~...r~;;,i.;,;,i , -.~". .'. -.r .3! '0 IQ -------------- ----..-- '._--- ---- --~~-----_._-- . - . ""~ h~I!OliI 0'00' 'J. '~,<~OZJ .3..0E',I~.It_.S ~ N ~ ~l ~6' "1';:~~ N ~ !9:~Er E-41~ i 6'1 r- . .." ',.) '-) ...It- l....; :loCJ'-.. Q'. '(IN:" \3, ~", , . ',- r Ce'r , ~ \., () ~pO 19- ~c..l( h'r,~. It: 1l'P'j" --,. '0 Ii ."j . h.~, - , +- A o .:..: cj J'It--' I...: - :;- . I 0 . , :1 '" .. , . v - .. b t- . j N <t ! - "I vi i q \ ~ " , "'l~..OZ. v.trl>"I~ !Ai . o :! . N <t i ~~'^ pwnos ,s;:.... .3'661- , ;, 'f - _.~ .~-~ --.....---.......- ..;- 0'001 A'VM '0 .::Ie \/I ..J. ._.._ .LH91ti -- c ~~ v 0- .- {; 6 '5 . 0 Vl "VI! 1111 1 ~ \ft-~ ;) . ' . - :P.r o ~ V ..:r; ~_c.: ')~ ~ i -""'! ~ '> ;f <;' . ':'r- "'~' 3 ~ . ~~, Ii .~1' ",,\:.'1:'2 v ~, ~. (' ~ . . '"" ':)! ". 0 ,. ~f>t'~~.j~ ~ 'J.~ ''t' a.. "~~,,.'Vr APPROVED AS NO ~ f1 ~ ~, ~ Q ,)ATe. ~ ti I,~ ~ -jJ j ---Pel. BY:~ I t.:?'I':Ff DUP.DillG DEPt.Rm' -" I ';5.2660 9.\.M to 4PM FOr\9 .~~R,. i, ~rF-::rtE n,~-.t:FllI.lN(i FOl'~:O,'\. T:~'~! en. ~,-tRT FR~~"'~!NG ~_. f~..~ t.~r:G r.,~":p~-:'i"crJ :;. .:':f-:r:: CC;l/i:"t~:r; p',;s OFt:.:V !:::~ ~" r::~L '-,'r::n !C:; CCMPLliE:: r~OT r.Lro"orlSi..p..~ F:JR D~~tC:'! c'- (.:l~:E'lJCTlCN EPRO"~ ~. ,'.I, cc~:Uf".'."'-tl MUST K'T RtQ.!...Ul;N~C;~, . '.,.- r:.Y.. SlAT:: '~;'~':': Ml~ T.O hQ...~I~;,G CODE ~ _::.;:,:.... ~ ~ ~ --......,0 Z ~Z 0 "- ~-t ill ..JQ ~.Jlt. C.J ~ Ol-I~ O--:U"'~5 a.~<[ Oa ~~J lJ)~ ~ z ~ >- g ~ Z w I z~. ~. 5 '" ~ ~ ~~...~~i' =.( 0' '... ~::,",,::y_.:c~.=g gO.'4 :-{ ... .~ _' . _. '" :a <. 'i ., ,1 .:~ ;; ~ ~ o~~ " '~~5 7.: <C.,. ~I - . U G ~ - ".' ':'.' }~! .~: ;i ,:; ;,1.:'i ~,~ :;,; .... ."" "' : .: :~?- .~ ,: ", ,; 1'; J 5' i Ii 1 i i;.:'i..; ,_. . . .;- '~ ':;:]J~o:li~l '., '-'.~ l- ;;:.:2 0 ~ i:.'~?~:'i h.:t!S; t \l .s: 01- o ...: ...-.--.-..... .-.----...,.-.-----.....-...--- .-..- --., -.-.-" ~ ~ , ''-3 Itr==--....".....-.~ LS=-- J ~ c:::J ~ i 0> ~ VE!l fC.~"~-- .c::::-" .--.......::;;.:;, , - i . ..;~~~-::.!..._--.J :.. ~..t II .,. \) o ~ E ~ ~ ~ tI 0 0 - ).. ~ CI ,- - (J II It .. ~ 0 f!J _NO.1 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) K<^ 7>j~~( 1~ ..:.L N~ Z Dote .-!.7-.'?::!?........................................., 19Ze Permission ~by g~~to~ ' k 00 , . ~ ~J(..~.~...~...~ .A "j( '"~~:~ ...~~/S:7.;?7..................................... )(~il (! \/ (,I,) _. . -/ ../ .......9I.~~.....f.J(,$.."/"...!./.?.1./ _ ,/2 4 to~~...~.......~~ty......~..~.....~........~~ ~.".........................................................;.......................................................................................... at premises located at ...L.Z5....~..a.....~~......................................................... .................................................~~~........................................................................ ................................................................................................................................................................ County Tax Map No. 1000 Section ......>..2.If....... Block .............9..... Lot No. ......:...2........,.. pursuant to application dat/t,;.7j.~9ft.O........................., 19.2~., and approved by the Building Inspector. /' ' Fee $...~&. Rev. 6/30/80