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ELIZABETH A.NEVILLE /0, 00%
Town Hall, 53095 Main Road
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TOWN CLERK ® % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � i Southold, New York 11971
MARRIAGE OFFICER Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "�®� ,i� Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER ��'� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2961 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JASON O'DELL
Address 1: PO Box 648
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-01-0206
Name Of Owner O'DELL, JASON
Mailing Address 1 PO Box 648
City St Zip GREENPORT NY 11944
Property Address 1 2864 SOUND DRIVE
City St Zip GREENPORT NY 11944
Tax Map No. section 33.00 block 2 lot 51.000
Cross Street WESTWOOD LANE
Building Permit Number Cross Reference:
Issue Date: 12/26/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ���/PP Gy Town Hall, 53095 Main Road
TOWN CLERK o - % P.O.Box 1179
REGISTRAR OF VITAL STATISTICS +,i Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `=y_'�Ol *is"
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER���,��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 6, 2002
Transmitted herewith is a copy of application No. 3085 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jason O'Dell
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: ' -e.--; .� `
7/1---4?Lide
Signature
42/0 o2—
Dated
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OFFICE OF THE TOWN CLERK ,t'' I
'0Oillireix7--TOWNOFSOUTHOLDTOCLERK1'
NEVILLEV�► Application No.
ELIZABETH A• ,
P.O.BOX 1179 Construction
-
SOUTHOLD,NEW YORK 11971
Alteration
Telephone O,jfor • $10.00 -Residential
(63t) 765-1800 = 1 $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
APPLICATION DEC 6 2002
for
CONSTRUCTION or ALTERATION PERMIT Southold Town Clerk
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE Ve(h4e, G sat
APPLICANT NAME: J f . Oa'(1
APPLICANT ADDRESS: IOOom CL18
Grecrrr} by l (crit
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Nevi Ye514 .14,1 12,311)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION': •
. OWNER OF PROPERTY: Jtiso-. ok. 1I `-4 Fjor
OWNER MAILING ADDRESS: P b13,v G Y
bra., r>,rl wA-i 01/1
OWNER PROPERTY ADDRESS: 21165 Snv-1 Drive
Greer 0\-1 II� I�I
TELEPHONE NUMBER OF CONTACT PERSON: G31 4'11 ¶HSI
TAX MAP NO. : Section 33 Block 02. Lot 51
CROSS STREET: 1 vin- wood �hr�
BUILDING PERMIT NUMBER CROSS REFERENCE:
p- QDLI�
Signature of Applicant
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RECEIVED BY: Air
Town Clerk's Office
DATE: •
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