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ii, <br /> a\--b00109.ag <br /> MARION COUNTY BUILDING INSPECTION DIVISION <br /> -����;• 5155 Silverton Rd NE D EcE_V I <br /> i[ <br /> Salem OR 97305 Li <br /> 11111111 (503) 588-5147 JAN 08 2021 <br /> Fax: (503) 588-7948 MARION COUNTY <br /> DUILDING INSPECTION <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> \.I <br /> DATE: ( a-r I tir'..3'02-0 MCBI File#: <br /> SECTION 1-APPLICANT INFORMATION <br /> 1. Property Address: 11 d( C dar bey Property ID#: <br /> Ga-fs ►tL. i73LtL <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: ....3}' I Cal Bb(LS+ Telephone#: 425 - . 13 - a 1 (Da <br /> Mailing Address: 11 CI 0..e.L ICt k- <br /> Gxa- `-c-S i 0R. q?3`t°CO <br /> 3. Describe� type of facility the on-site sewage system will serve(business,residence or other): <br /> iii Single Family Residence <br /> ❑ Business EXPIRED <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> ❑ 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:\FORMSISEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev:8/10,04/12 <br />