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TD) ECENED <br /> NOV 18 2020 <br /> MARION COUNTY BUILDING LNSPECTIONwtARDIVISIOi «N COUNTY <br /> 5155 Silverton Rd 1�'E <br /> n._._...:.: BUILDING INSPECTION <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: I j - 1 - •90.)-0 MCBI File#: <br /> SECTION 1-APPLICANT INFORMATION <br /> 1. Property Address: 692 L( tit/ C .-g a Property ID#: <br /> (Q-f-Ls ,t)R- an 3 cite <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: t- litL.1+0h 4— L e1'ephone#:1 teD -L(&S -0823 <br /> Mailing Address; eg 2- -1 (A! (a...44 -yJ f-. 6 4.1-e, DR_ q11:41.,, <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> le Single Family Residence • <br /> ❑ Business <br /> U Other: <br /> 4. Type of on-site sewage system pen-nit application being proposed for this property: • <br /> ❑ New Installation Permit <br /> ❑ Repair Permit <br /> ❑ Alteration Permit for: Replacement Dwelling ❑ Bedroom(s)addition <br /> ❑ Other changes in land use involving potential sewage flow increase: <br /> G:`•.FORMS\SEPT1CLApglication PacketslS-39 LUCS.doc MC:S-39 rev:8110,04/12 <br /> Z'd 8909L68£09 sena°40 Aln d99:170 OZ 8 6 AON <br />