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O0- LI -EVA L <br /> j <br /> ►� ova �, <br /> f .• MARION COUNTY BUILDING INSPECTION D � <br /> ► 51 s siilverton Rd NE ! <br /> :.�. MAY <br /> Salem® 97305 07 2018 <br /> (503),588-547 <br /> Fax: (503) 588-7948 MAF3N <br /> COUNTY <br /> BUILDING INSPECTION <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: if�16//S MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> I. Property`Address: 6276/ T55 01- RD Property ID#: <br /> Section:_�— Township:64I TC-; Range: Tax Lot ll: <br /> 7P4c/i90 <br /> ry. Name of Applicant: ,� rs /CK..!?4;t0- '-F_ Telephone n: l7 2‘9 " 2245 <br /> Mailin 14 Address_ 7075 WievaW 57a. <br /> :54-1.5A1 q7jot <br /> Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> %Single Family Residence <br /> • 3 Business <br /> • Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> New Installation Pcrmii <br /> • Repair Permit <br /> • Alteration Permit for: !®f Replacement Dwelling 0 Bedroom(s)addition <br /> O Other changes in land use involving potential sewage flow increase: <br /> Ci: FOR ut:;.tit:3'1'fC.�\t�pli�ation Pae s S-3e{.(Jt � f K MC:S-39 rev:8/1O.04;12 <br />