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r _ i <br /> MARION COUNTY BUILDING INSPECTION DIVISION <br /> —,..-....-.,.—....,-,...,.,, 5155 Silverton Rd NE <br /> Salem OR 7305 <br /> (503) 588-5147 <br /> Fax (503)588-7948 <br /> LAND USECOMPATIBILITY STATEMENT (LUCS) SEP `1. 1 2023 <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> i:::: • ..:::'-+,P n <br /> DATE 1. O 23 P 2 MCBI File#:22- 005315p RaiLif-r <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: I 760-5 Peet 11+er icy. Property ID#: <br /> 144bbard .. 0R- /70 -2 <br /> Seotion: Township: Range: Tax.Lot#: <br /> 2. Name of Applicant .Ross Neoicivik- Telephone#:- 503 .t-S.1-:$7'!'Sis,q <br /> , . <br /> r z <br /> Mailing Address: I.76t7S— Par ni e' oer _12 1 _M e <br /> AteeriS ey2. .`77113g. <br /> 3. 'Describe type offadility the on-site sewage.system Will serve(business,residence or other): <br /> 0 Single Family Residence <br /> AL Business <br /> ID Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> New Installation Permit <br /> CI Repair Permit <br /> 0 Alteration Permit for: 0 Replacement Dwelling U Bedroom(s)addition <br /> U Other changes in land use involving potential sewage flow increase: <br /> GAFORMS\SEPTIC1Application Pacicets\S-39 LUCS.doe MC:S-39 rev:8/10,04/12 <br />