Laserfiche WebLink
��' "'"������ COUNTY BUILDING INSPECTION DIVISION <br /> MARION <br /> ~%� y.� 5155 Silverton Rd NE <br /> MO Salem OR 97305 <br /> (503) 588-5147 <br /> Fax: (503) 588-7948 CV— <br /> REciEhyhD <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS `�O 18 2022 <br /> MARe ON COUNTY <br /> BUILDING INSPECTION <br /> DATE: rQV 7 , 2)-bZZ- MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: /TVs. N uuy L Z 5 L, Property ID#: <br /> dfi.14 Lc—, 49 R. 97 6-19 <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: F Q ci PeAferfort Telephone#: t' 3 9 g> -slO s"l <br /> Mailing Address: 2© 13 LP'C -S q Cr <br /> xd-Cia..k L.0- o 'R 773 Sr <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: f`,`i-t 1' 'ii <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> .261ew 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\Application Packets\S-39 LUCS.doc MC: S-39 rev: 8/10,04/12 <br />