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EIECENE <br /> MAR 0 7 2019 CL <br /> MARION COUNTY <br /> • BUILDING INSPECTION <br /> 7 � <br /> MARION COUNTY BUILDING INSPECTION DIVISION I -'' 1lc/ <br /> 5155 Silverton Rd NE <br /> .11111 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 /> DATE: ?r'-`P MCBI File#: • <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address:\`AO Mu k (Aim Property ID#: <br /> `C6\ CAL X1 1` - <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: N Q\ .VXCQ l)C5V 11 Telephone#: <br /> Mailing Address: " 3)' 51)`-\ <br /> • \�J,�C`( o \ CSL oc-in • <br /> - <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> lel 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 /> 0 Repair Permit GY\\ <br /> O Alteration Permit for: 0 ReAcement Dwelling 0 Bedroom(s)addition • <br /> ❑Other changes in land use involving potential sewage flow increase: <br /> • <br /> G:\FORMS\SEPTIC\S-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />