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• <br /> MARION COUNTY"'MIXING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> Iii Salem OR 97305 <br /> (503)588-5147 <br /> Fax:(503)588-7948 <br /> • <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: I I—aa- MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: iqi/ &Iv 10444-r2a. Property ID#: /6 6.3 I <br /> S ow_ <br /> Section 06 Township: I 4"/flange: 26 Tax Lot*: /17CO <br /> 2. Name of Applicant 'Ce4t,r, 01,4.,..t. 22c, Telephone# 6c'? 6.741- al <br /> Mailing Address: • a) azic c---7 <br /> • e --37 ,C1 <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> Id:tingle Family Residence <br /> CI Business <br /> 0 Other: <br /> • • <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> CI New Installation Permit <br /> ; Repair Permit <br /> 0 Alteration Permit for: CI Replacement Dwelling CI Bedroom(s)addition <br /> 0 Other changes in land use involving potential sewage flow increase: <br /> • <br /> thWORMASEPTIOS-39 LUCS.DOCX Rev:8/10,04/12,03118 <br />