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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: d L'/q 723 MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: 2—E Z I Fo vEN 1 operty ID#: <br /> gpt.Er�� 02 4.2.117 <br /> Section: Township: Range: Tax Lot#: <br /> 083W08B001400 <br /> 2. Name of Applicant: Dog& K P,4MAE a.,ems Telephone#: . 0 3 -y 2 Z- 7 a�c <br /> Mailing Address: S. ? y ) stafe- <br /> SAi-En 02 ' ?/) <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> XSingle Family Residence <br /> ❑ Business <br /> ❑ Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> j4 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:IFORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev:8/10,04/12 <br />