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L <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 i'(LUGS) <br /> ,\ FOR ON-SITE SEWAGE SYSTEMS <br /> I?A4'[F,.\ a'.2 3 - )44> MC131File#:..._... <br /> SVCTION�1,—APPLICANT INFORMATION <br /> 1. Property tldress:2.51 '/e , cv ,DY ......... ........ Property, )II:Gb/ ..:2-4—fie De:1f3Ocs: <br /> Section. L.2-- 'Township: t�aaS Ra ge: Tax Lot`t: <br /> 2. \ „ 00 ex;z> <br /> ? <br /> Name of Applicant:(.&�� ✓�,�(.y�' Telephone tf:‘‘.„1-..3.7s:r'r'5.7___ <br /> mailing Address: .. Cet; C-v )',,�,.� r�f�. <br /> Fc"- 1,610-ii i, 114,t Lear•*,y 4l 4,,,_,/,,,,e ` ,, >C- +-i/z i 6t q73 <br /> 3. Describe type of facility the onsite s waA system will serve(business,residence or other): <br /> B <br /> • 6 Single Family Residence / <br /> LI Business / <br /> LI Other: ._._. ,// <br /> 4. Type of on-site sewage syst nr permit application b6:'ng proposed tin this property: <br /> r <br /> d.1 New installatiotsermit <br /> LI Repair Permit <br /> `_1 Alteralioa)eermitfor: ;U Replacement Dwelling ...3 Bedroom(s)addition <br /> I Other eh ages in land use involving potential sewage no increase: <br /> tiJoRmstsEn i)0Appiiestion 1'<tr eL'S-39 1_tJC:S.i've NIC.:S-39 rev:5/0.(51111 <br />