HomeMy WebLinkAboutZ-5918FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. 25918......
THIS CERTIFIES that the building to
Map No.. xx= ...... Block No...x .
conforms substantially to the
daWPl
Wore -April ,� 23 ,
Date ............ )%y ....7 ..... , ., 19.24
Gated at ...p/6 �gneatTiati Avg• .. Street
yLot No. 3=.. Fishers . I slan4 ..N.Y.... .
pursuant to which
259 ,
dated ........ NXNR.M�y..1719 .. }was issued, and conforms to all, of ;the require-
ments of the applicable provisions of the law. The occupancy for which this, certificate is
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issued is .. Private.. one..fami.ly. . dw.a lling... A.. 2. N .0 . Ac c®s s4}�r, build inga
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The certificate is issued to ..Gamel• S .]Polk • • • to Elizabeth. Bart*r...
(owner, lessee or texi t)
of the aforesaid building.
Suffolk County Department of Health Approval . pre-existing • • • ' / • • • • • • • • • • • •
UNDERWRITERS CER!TIFICATE No. pro... existing ..............................
HOUSE NUMBER .... none ..... Street ..........................................
..........
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