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MARION COUNTY BUILDING INSPECTION DIVISION <br /> --� � :� 5155 Silverton Rd.NE <br /> Salem OR 97305 <br /> (503) 588-5147 <br /> Fax: (503) 588-7948 <br /> RECEIVED <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) APR 17 2024 <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: 4- `7 ^2 MCBI File#: • <br /> SECTION 1—APPLICANT INFORMATION <br /> • <br /> 1. Property Address: I B ' ' (Xr\V% coin l`11 J 15T Property ID#: Cif€3a9/14 <br /> C Ck 5 02 4134o <br /> Section: Township: Range: Tax Lot#: 09 SE;277 D fA6 vgoo <br /> • <br /> 2. Name of Applicant: A-r, j tfioo Co60P;,2 Telephone#: 0 `3e)3 33 <br /> Mailing Address: • PO ?NO-TN (o[ <br /> • YV\ t \\ C�- �I D Z ltl 3 Q <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 /> • <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 /> • <br /> G:WORMS\SEPTICIS-39 LUCS.DOCX Rev:8/10,04/12,03/18 • <br />