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FORM NO.3
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TOWN OF SOUIHOLD
BUILDING DEPARTMENT
TOWN HALl
SOUTHOLD, N.Y.
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BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 22558 Z
Date ....................pk............................ 19..9..r
Permlsslon Is hereby granted to:
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County Tax Map No. 1000 Secflon ..A2~.......... Block .......t?3.......... Lot No. ....~/................
pursuant to appllcaflon dated .............../#9........................ 19....9".. and approved bylhe
Building Inspector.
Fee $....16.7.~.......
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Rev. 6/30/80
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