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MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> ir:17; Salem OR 97305 <br /> • (503)588-5147 <br /> Fax:(51)3)588-7948 <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: -.2-4YS) MCIII File/I: <br /> SECTION 1—APPLICANT INFORMATION <br /> I. Property Address:2.511rkeee Propert,y ID li:6i .224DelPz\r, <br /> Lie <br /> Section: .2 2- Township: Range: Tax Lot <br /> 2. Name of Applicant:1,1,44,.8,341,,,,frzeyS,p1:, 4.4- Telephone Ihs-i.,SLE2S- 6711,_ <br /> Mailing Address: gnstJ <br /> el 3 <br /> g738'9 <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> dt.Single Family Residence <br /> LI Business <br /> 'LI Other: <br /> 4. Type of on-site sewage system permit application being proposed tier this property: <br /> • New Installation Permit <br /> • Repair Permit <br /> LI Alteration Permit litr: A Replacement Dwelling j l3edroom(s)addition <br /> • Other changes in land use involving potential Sewage flow increase: <br /> ‘i:\Foitms'.snn FICkApplicAion Peat:OS-39 1,11CS.dee MC:S-35 rev:Si I 0,01112 <br />