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• <br /> MARION COUNTY BUG INSPECTION DIVISI CE�VIE <br /> BUILDING <br /> ton Rd NE <br /> 11111111---m— <br /> ILDIN <br /> Salem OR 97305 <br /> (503) 588-5147 FEB 01. 2021 <br /> Fax: (503) 588-7948 MARION COUNTY <br /> BUILDING INSPECTION <br /> ZZ`0C51 (95- <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: I 11 L010 MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1)1 Property Address: 122 Ne.3b(2-12W ST Property ID#: <br /> WinS r - ii?,M-o <br /> Section: Township: Range: Tax Lot#: <br /> 2.1 Name of Applicant: WC\k \ , SQ,\ � L LS y Telephone#: (SDV` 1 151 <br /> Mailing Address: C)116CACCt `I\ j S\\v w0Y\ b'(-1 Cl 1 3%li <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> 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 /> 04 Repair Permit <br /> ❑ 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 />