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0 -- iIgo4-7 - 2o <br /> EC"EbiVE <br /> MARION COUNTY BUILDING INSPECTION DIVISIOI\ <br /> 5155 Silverton Rd.NE SEP 24 2018 <br /> Salem OR 97305 � <br /> (503)588-51.47 �� �� COUNTY <br /> • BUILDING INSPECTION <br /> Fax: (503)588-7948 <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> • <br /> • <br /> DATE: ///� )0'16- • MCBI File#: • <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: V370 Property ID#: <br /> 5c2.1.e In 04 q-i 3t5C • <br /> Section: Township: Range: Tax Lot#: • <br /> 2. Name of Applicant: rAiss.,,G nt-61`4. Telephone#: . <br /> Mailing Address: S Pe,e <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 /> 'kg'Repair Permit <br /> ❑Alteration Permit for: ❑Replacement Dwelling ❑Bedroom(s)addition <br /> ❑Other changes in land use involving potential sewage flow increase: <br /> • <br /> • <br /> G:\FORMSISEPTICIS-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />