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EC -FrIVErri <br /> A MAR 2 2 2021 <br /> • <br /> MARION COUNTY <br /> • Rl 3 INSPECTION <br /> MARION COUNTY BUILDING INSPECTION DIVISION 21--CA.,73 225`-`j3 <br /> —�-��% :� 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503) 588-5147 <br /> Fax: (503) 588-7948 <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: 3? ( 2..\ MCBI File#: • <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: 70 Property ID#: <br /> Section: Towns i •: Range: Tax Lot#: <br /> Applicant: 4f t i; Telephone#: 831?�2. Name of APP �� f <br /> Mailing Address: 70 h 64409`tW t- 6 4--eS 6 <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> ingle Family Residence <br /> O Business <br /> U Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> ❑New Installation Permit <br /> U Repair Permit <br /> ❑Alteration Permit for: P replacement Dwelling LI Bedroom(s)addition <br /> • ❑Other changes in land use involving potential sewage flow increase: •-. • , <br /> • <br /> G:\FORMS\SEPTIC\S-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />