Laserfiche WebLink
,„ ? ,„„ MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> 1111111 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: 1'-1'c3Q4\ MCBI File#: od 61 't/42 -/°/6/7/1 r <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: - l jC) F(tjr\t M Property ID#: \OS \ 9C„ 5 czo <br /> Section: Township: _ Range: Tax Lot#: <br /> 2. Name of Applicant: bekheA t, (S5o0,1 Telephone#: ,1 I d?L1 <br /> Mailing Address: 17� g- X L1 u .I ,��'. ►�'� <br /> —111,r►NeIr c� 01-13°1a <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> l 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 /> l Repair Permit <br /> O 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 />