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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
.Certificate Of Occupancy
No.'%�. ...... Date .... 19....
THIS,
THIS, CERTIFIES that. the building located at .. ��Y/S , l`�i�'t.t� ..Y� Street
Map No. ".'Xxx ....... Block No: :.:.x....Lot No....slrsst....... .
nts
conforms substantial) to tYie�eotxiremefor carte f amil� dwel�in
YItn fotll��Efenet�'-�,'
3r before �. cext: f�f.oate of 6ecuparicy
ate? . ,. 19 . f pursuant to whichkTor�.�.c,3 .. .
dated ............ A -Lig..... 24. , 19.r216 . , 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 .1i,C..Privv tF). y. zj. ois ? 7 in g,1} t Fav is b d l ?l e a s cif �.2/
The certificate is issued to .� o I: < .. T�;c�C3;��� .. J'?' .................... .
(owner, lessee or tenant) -
of the aforesaid building.
Suffolk County Department of Health Approval. ..�' �' .exist Yah
UNDERWRITERS CERTIFICATE No. ...... ... .
HOUSE NUMBER .... �? : ..... Street ... iq �a use A rW .. fishers I s d ............................
cl ' s , v . °M�f'- ' � ;Y . a- y=;the-, « . This C/0 ` overs douse &trach _ 2...:... .
Chandler,&-Palmmer 6/4/76
Building Inspector
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