HomeMy WebLinkAboutZ-4049FO~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. ~ ...... Date ............ NOV..-.
P1
THIS CERTIFIES that the building located at .
Map No...~ ....... Block No .... ~ ..... Lot No..~ .... ~ttt.t~k...N,Y, .......
conforms substantially to
......... ~ 2 ,,.. ;., , ; ~, · .......
....................... , D''-',~i'-'~'-d~'~-t"'~]8~l gini require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ... ~iV!$~. ,0~..r,~!;~. !Wlli~ .....................................
The certificate is issued to . .~or~ .Fork. ~lderl. Inc, t -. ~ ................
(owner, lessee or tenant)
of the aforesMd building.
Suffolk County Department of Health Approval ..... ~,R~ ..........................
Building Inspector