Laserfiche WebLink
• <br /> MARION COUNTY BUILDING INSPECTION DIV1 gc-RllvEr, <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 NOV 0 7 2023 <br /> (503) 588-5147 MARION COUNTY <br /> Fax: (503) 588-7948 BUILC ING INSPECTION <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: 11- 1 2 3 MCBI File#: 693 e, D4 r• <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: \S c ) ObaQ- 'Q`� ' Property ID#: It 6Y 5 <br /> Section: b ,5 Township: t../ _ Range:1,g 4 Tax Lot#: <br /> 03►00 <br /> 61 <br /> 2. Name of Applicant: HLFy Tele hone#: 5 0 c, /PP p � 1S��1/5 <br /> Mailing Address: I 1 � O j �1 <br /> 9 ?3 ?S <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> U'Single Family Residence <br /> ❑ Business <br /> ❑ Other: <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 /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev:8/10,04/12 <br />