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fes. <br /> MARION COUNTY BUILDING INSPECTION DIVISION <br /> - 5155 Silverton Rd NE <br /> --• .`� 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: .1 ,�,q � 7 0200 MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: 697 IBJ.CLCAV Ct Property ID#: <br /> (yiK6i , `1 `fC <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: <br /> Telephone#: �7 9 <br /> ��,Q 4,k,c7"-- p <br /> Mailing Address: 09,9 98 .lea ko)/A-1-6-2- <br /> 6064dOi+ <br /> 4;6066 (A • � �� <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> Ai 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: )4 Replacement Dwelling ❑ Bedroom(s)addition <br /> ❑ Other changes in land use involving potential sewage flow increase: <br /> /VA <br /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev:8/10,04/12 <br />