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9 Lg 11) <br /> DEC 012022 L«.' <br /> • <br /> MAHON COUNTY <br /> Y <br /> DUILDIkNG INSPECTION <br /> MARION COUNTY BUILDING INSPECTION DIVISION <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 /> • <br /> DATE: June 21; 2021 MCBIFile#: <br /> SECTION 1—APPLICANT INFORMATION • <br /> 605 S PACIFIC HWY <br /> 1• Property Address: _ Property ID#: <br /> WOODBURN, OR 97071 <br /> • <br /> Section: Township:__Range: Tax Lot# <br /> 051W18D 000300, 000400,000500 AND <br /> 000600 <br /> 2. Name of Applicant: ALAIN REBEYROL Telephone#: 541-683-5762 <br /> Mailing Address: • 30 E BROADWAY, SUITE 151, EUGENE,.OR 97401_ <br /> • <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> O Single Family Residence <br /> 121Business <br /> ❑Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> New Installation Permit <br /> O Repair Permit <br /> ❑Alteration Permit for: ❑.Replacement Dwelling ❑Bedroom(s)addition. <br /> ❑Other changes in land use involving potential sewage flow increase: <br /> G:\FORMSISEPTICIS-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />