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, <br /> • <br /> ,-EC -2, 1] YED <br /> "' " MARION_ COUNTY BUILDING INSPECTIO - VISION <br /> �% 5155 Silverton Rd.NE j U,_ c Z 2022 <br /> NMI Salem OR 97305 <br /> (503)588-5147 MARION COUNTY <br /> Fax: (503)588-7948 BUILDING INSPECTION <br /> • <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> • <br /> DATE: 7 - 2-1" MCBI File#: • <br /> SECTION 1—APPLICANT INFORMATION <br /> • <br /> 1. Property Address: S J I S Se I\ev1 ► t7 Dr' "( Property ID#: <br /> 7a,,11e. w°id( 51--►l eS kb 2—. 1- S 13 l a ck <br /> Section: Township: Range: Tax Lot#: 6,673 0'/j P 13 00 *o D <br /> D0 i'50,, J t d -i <br /> 2. Name of Applicant: J q cl-so vl ()4.lwafe.0 1 GJKct-11KL Telephone#: S 0S S 5 9 61 71 <br /> Mailing Address: • Po $ 3 g i Z S -Ie m. (.9 e ' 7 3 o z <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 /> • <br /> 4. Type of on-site sewage system permit application being proposed for this property: . <br /> ❑New Installation Permit <br /> ❑Repair Permit <br /> rlteration Permit for: O placement Dwelling ❑Bedroom(s)addition <br /> ther changes in land use involving otential sewage flow increase: <br /> �Gee g LA. \Y.d � g r AkA \,9 v\ , \� ���T l � 17 <br /> . G:IFORMS\SEPTIC1S-39 U S.DOC Rev 8/0,04/12 03 8` w t.t^` 0'� efilaad C <br />