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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 /> DATE: ham//A 9 3 MCBI File#: • • <br /> • <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: /v 14 S Oat- S(. Property ID#: 6-1 G- 0 2 <br /> Section:3 - Pub Township: Co 5 Range: 1 id Tax Lot#: 1-66 . <br /> 2. Name of Applicant: M;Le 1<o 41-7 Telephone#: <br /> Mailing Address: • <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> a-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:\FORMS\SEPTIC\S-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />