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MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> NMI Salem OR 97305 <br /> (503)588-5147 <br /> Far:(503)588-7948 <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> (', s�FOR ON-SITE SEWAGE SYSTEMS ,/' <br /> DATE: - j( ra)- I J MCBI File#; /,�/- U 0619- <br /> SECTION I-APPLICANT INFORMATION <br /> I. Property Address: 5`O P.SgnA-IAc-- Property ID#: <br /> r�'� Co4.Pu oe <br /> Section: t t Township: t{ Range: 3F- Tax Lot it:CC6 °.63 <br /> 2. Name of Applicant: SEC SVru(AW Telephone ft:, SD3-tag'SiOY <br /> Mailing Address: P'o, 92,0.I CNA <br /> to\\ et' 973k <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> .Single Family Residence <br /> O Business <br /> ._. Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> O New Installation Permit <br /> 9CRepair Permit <br /> O Alteration Permit for: 0 Replacement Dwelling O Bedroom(s)addition <br /> O Other changes in land use involving potential sewage flow increase: <br /> O:tFORMSVSEFITGLIppllmioo PackemlS.39 LI1CSAoc MO 849 rev:6/10,04/12 <br />