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d14-61)5&51 <br /> [ITCEIVED <br /> MARION COUNTY BUILDING INSPECTION DIVISION JUL 09 2024 <br /> 5155 Silverten Rd NE <br /> mII 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 /> DTE O , 22 MCBI File if: <br /> SECTION I. APPLICANT INFORMATION. <br /> I. ProPerty Address: 6 G co-,. Property ID <br /> 5lk 55 8 # <br /> vy 603V--'1 <br /> Section: TOwnship: Range: Tax Lat:#: <br /> 0 9 PA/ i B1300-5 °") <br /> s-os - 513- e <br /> Name of Applicant: MA2/1.. L 'Telephone ff 5c) 3 5-0- /1 . <br /> Mailing Address: I 49 r-c-\ S <br /> -ev fr.1 7 3 <br /> 3. <br /> Describe type of facilitythe on-site:sewage system will serve(business.residence or other): <br /> Single Family Residence <br /> CI Business <br /> CI Other:. <br /> 4. Type of on-site sewage system permit application being proposed tbr this property: <br /> CI New Installation Permit <br /> Repair Permit <br /> Alteration Permit for: CI Replacement Dwelling Cl Bedroom(s)addition <br /> Cl Other changes in land use involving potential sewage flow increase: <br /> (3:\FORMSNSEPTIC‘Applicatitin Plickets\S-39 LUCS,dix MC:S-39 re.v:800..04/12 <br />