HomeMy WebLinkAboutZ-4822FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at ~k~. lt~teve. &~ ........... Street
Map No.. XX ........ Block No...XX ..... Lot No.. XX.. ~tii~k. ~, .........
conforms substantially to the j~~~~,~j~i~j~ ~
B~ befe,e A}r~"~)'" 19.~ pursuant to which ~}~
........ '
dated ....... ~ep~ ....... 19., 1~. ~2, was issued, and conforms to all of the require-
ments of the applicable p~ovisions of the law. The occupancy for which this certificate is
issued is . ~ate. ~ .~a~ly d~ell~g .......................................
The certificate is issued to . J~nl~ .~r~n ....... ~el .........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ... ~e,. ~.~,~ .................
UNDERWRITERS CERTIFICATE No .... 1~0...e~il.~nl ...............................
[lOUSE NUMBER. '~0~ ........ Street... II, oo~'o. · ./I'¥~ ...... l/i~t, tdl'['llll¥ .................
... ':~ ( /~_~
..... "' ..... '1
Building Inspector