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TOWN OF SOUTHOLD
BUff.DING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at . ]I/B. l~.eltt~l. A~t~ ....... Street
Map No..~ ....... Block No...~ .... Lot No.. ~ ...Fl~h~l'a ~Isl~l~d.. l[,~o
dated ........... 8$p.~ .... ~., 19.7~, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which thJ.~ certificate is
issued is .. l~'J. vat~ .alne..fam;l=13'. d~m~.. (. Lt. &plnl"O~lad .by. ~B~.
The certificate is issued to . .{ieltleB. & .gt'&e~ .Le~ ......... O~el, m .............
(owner, lessee or tenant )
of the aforesaid building.
Suffolk County Department of Health Approval . .p~a-,. ex~mt~ ..................
UNDERWRITERS CERTIFICATE No..pr~.~ ........................... -..
HOUSE NUMBER .... ,~ ..... Street ...........................................
...........