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MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5 5155 Silverton Rd NE <br /> 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: (( =/23 MCBI File#: • <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: 30(0 11\konlTdr Q.dad Property ID#: 5 16 533 <br /> Stilfalkcn QR C175/ <br /> Section: i 5 Township: ( U/ Range:Z6 Do Tax Lot#:0 0100 <br /> 2. Name of Applicant: I vt10V Mt Telephone#: 503 $19 9 P .8 <br /> Mailing Address: QC bOk. 2045 <br /> &Iv(xr r D . g738I <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): ' <br /> 0 Single Family Residence <br /> 0 Business <br /> 0 Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> tif New Installation Permit <br /> 0 Repair Permit • <br /> ❑Alteration Permit for: 0 Replacement Dwelling 0 Bedroom(s)addition <br /> 0 Other changes in land use involving potential sewage flow increase: - <br /> t <br /> G 1FOR,\LS\SF_'TIC\S-39 LUCS DOCX Rev 8/10,0/12 03/18 <br />