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. MARION COUNTY BUILDING INSPECTION DIVISIOi; I G V� <br /> 5155 Silverton Rd NE D <br /> Salem OR97305 MAR 22 2022 <br /> " <br /> ,111111 <br /> (503)588-5147ll <br /> COpl� <br /> Fax: (503)588-7948 B` Ol-D( �11V p� �Tl�� <br /> `� <br /> LAND USE COIPATI.RILITY STATEMENT(LUCS). <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: 3-15-22 MCBi File.#: <br /> SECTION I:.—APPLICANT INFORMATION <br /> 1. Property Addross 8708 Parr Rd Property ID Y: <br /> Gervias, OR 97026 <br /> Section: Township: _ Range: Tax Lot <br /> 1001 <br /> Parcel#2, Partition Plat 2017-054 <br /> 2. Name of Applicant:Agafia KaIUgin, Trustee Telephone#: <br /> Mailing Address: 10807 Duck Inn Rd SE <br /> Brooks, Or 97305 <br /> 3, Describe type of facility the on-site sewage system will serve(business,;residence or other): <br /> O Single Family Residence <br /> i.3 Business <br /> M.Other: Church. <br /> 4.. Type of on-site sewage system permit application being proposed for this property: <br /> O New Installation Permit <br /> -0 Repair Permit <br /> tM Alteration Permit for: © Replacement Dwelling 0 Bedroom(s) addition <br /> U Other changes in land use involving potential sewage flow increase: <br /> No increase in flow. Relocating absorption system. <br /> G:`•:FORMS'\SEP:TI'C\Application Packets S-39 LjCS.doc MC:S-39 rev:$10,04/t2 RECEIVED <br /> MAR 2 i 2022 <br /> COMMUNNY DEVELOPMENT <br /> DEPARTMENT <br />