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' <br /> ' I <br /> • <br /> A-t5D 088 <br /> � a MARION COUNTY BUILDING INSPECTION DIVISION <br /> y 5155 Riverton R4 is E <br /> `— Salem OR 97305 <br /> `` (503)588-5147 <br /> Fax: (503)588-7948 ' <br /> - i <br /> RECEIVED <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS SEP 0 4 2024 <br /> . I <br /> rr-- <br /> DATE: 7 . �-4� ���'( MCBI File#: <br /> SECTION N 1-APPLICANT INFORMATION <br /> ' 1. Property Address: I r g C5� 1L5 ` ( i ga Property ID#: <br /> Section:. Township: Range: Tax Lot#: <br /> �t c1' (� t Telephone5-00 "41�1 �(3�7 <br /> 2. Name of Applicant: -'� � �� #: <br /> Mailing Address: ' •C- \J CAStT 9 <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 /> ❑Other: <br /> • <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> O New Installation Permit <br /> ❑/Repair Permit <br /> Cd Alteration Permit for: Replacement Dwelling 0 Bedroom(s)addition <br /> ❑Other changes in land use involving potential sewage flow increase: <br /> • <br /> G:1FORMS\SEPTIC\S-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />