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MARION COUNTY BUILDING INSPECTION DIVISION r-ji C! !J IE <br /> 5155 Silverton Rd NE { _ <br /> 111111 Salem OR 97305 MAR 16 2021 <br /> (503)588-5147MAHION `,COUNTY <br /> Fax:(503)588-7948 BUILDING INSPECTION <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: / /ato Ie2Oc 1 MCBI File <br /> #: <br /> SECTION 1—APPLICANT INFORMATION <br /> I. Property Address: 1/ I Id Ceti iro L Ave Property ID#: 59 S 8GI(o <br /> ecaes, g7341 <br /> Section: 15 4; 1 jy Towts p:J ,y))e age:,alas+ Tax Lot#:.5 +y,4 ,f '4 <br /> tmehalfo� liot44 j 71. <br /> 9 <br /> 2. Name of Applicant: isere5 ,, L3 yvcr Telephone#: 543-5g0" o`T9r0 <br /> Mailing Address: PD. 613y. i"! <br /> Da ttet o, &k 9138 <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> Single Family Residence <br /> ❑ Business <br /> ❑ Other: <br /> 4. Type of on-site sewage system permit 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:tFORMSISEPTICtApplication Packets\S-39 LUCS.doc MC:5-39 rev:S/l0,04/12 <br />