HomeMy WebLinkAbout4124-Z FORM W0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT G��EIoIE�
Town Clerk's Office
Southold, N. Y. APR
70NING 60ARf7 OF t i)PEAL
Certificate Of Occupancy
No.Z36 59. . . . . . . Date . . . . . . . . . . .Rovember-6. . . . ., 19 69 .
THIS CERTIFIES that the building located atSmith -Dr- north . • • . . • • . • • . Street
Map No.G....'nuck Block No.xx. . . . . . . .Lot No. —pt- I+102 . . . Southold.. X.I.
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . . . . . . . . . Nov. 8. •, 19.6& pursuant to which Building Permit No. .4124. z ..
dated . . . . . . . . . . . .NbV . . . 13 ., 19. 168, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . . . . . . . Private .ona .f amily. dwP-11 ing . . . . . . . . . . . . . . . . '. . . . . . . . . . . . .
The certificate is issued to . .. Lex f.s •ue a�r•3 zar�• . • • •Owr:er. . .. . . . . . . . . . . . . . . . . . . .
of the aforesaid building. (owner, lessee or tenant)
Suffolk County Department of Health Approval . . . . . . . . . . .b.h. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . � : �: . . . . . . . . . . . . . .
Building Inspector
House # 1540
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the land Zrvuyor9 inked 1 oc f rr
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to be valid
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Guart;ntess indicated hence s all nm SUFFO�.K /
only to the person for whoa.th sunrc►' CO., ,� ° ,G< D fi o W. �/an Tuy/ Sovi
is w soared and on his is. to ,
tY7�cem�sny,governmen.31 en ..d
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tti ins'atuiions or subs ueni
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