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•°' t ",„uu� MARION COUNTY BUILDING INSPECTION DIVISION <br /> --���� :. 5155 Silverton Rd NE <br /> ---------- <br /> Salem OR 97305 <br /> I <br /> (503) 588-5147 <br /> Fax: (503) 588-7948 <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: Y� , IBJ" MCBI File#. / 9-0.) 3 1_53-- (A/a-e- . <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address:(3)B lk1 C%-- Property ID#:7(... I (3!4/c3 y <br /> a44 �Ilis,& 97,37s— <br /> Section: <br /> 7,3rsSection: Township: Range: Tax Lot#: <br /> O(o IC1S-- CO0a°° <br /> 2. Name of Applicant: NQ S MCL Telephone#:S 2 3'Ss F /OLlS <br /> Mailing Address: ?.0 :—.-&- )e.- 9 <br /> Ji_ k- 9 <br /> 1O44s 144/115 / O .97575 <br /> 3. De.scribe type of facility the on-site sewage system will serve(business,residence or other): <br /> 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: ❑ Replacement Dwelling ❑ Bedroom(s)addition <br /> Other changes in land use involving potential sewage flow increase: <br /> / Mk- <br /> iEA/OSu ;(3) --___ <br /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev:8/10,04/12 <br />