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34— al-Q1Ate <br /> MARION COUNTY BUILDING INSPECTION DIVISION <br /> 1���� :• 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503) 588-5147 <br /> Fax: (503) 588-7948 <br /> • <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: S d! `1 e)® ''I MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: / 3 V ✓1 E l✓ Property ID#: <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of ApplicantWL t--V )A �� Telephone#:' 7 T 4 S1 <br /> Mailing Address: to 66 / ) 0 / <br /> • <br /> L 66 Anion/ OYL1 i 5"5 . <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 /> ORMS\SEPTIC\S-3 LUCS.DOCX Rev:8/10,04/12,03/18 • <br /> G.\F 9 <br />