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MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503) 588-5147 <br /> Fax: (503) 588-7948 <br /> _ VEDLAND USE COMPATIBILITY STATEMENT (LUCS) MAR 312021 <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> couNTy <br /> BUIL®NGNIN INSPECTION <br /> D���1 <br /> DATE: c� MCBI File#: p7 <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: 13,2_ ,E, Se,r14/1,1 Property ID#:03E2�Cc_�34' <br /> Section: 0 57 Township: 3E Range:.2‘Cc_ Tax Lot#i.51795V <br /> 2. Name of Applicant: Arlkirjo 15,7")s u.-4 Telephone#: 0.? /-3c?' <br /> Mailing Address: Po 609(105S �,//C a ®;; %•734. <br /> 3. Describe type of facility the on-site sewage system will serve(business, residence or other): <br /> U Single Family Residence <br /> ❑ Business <br /> --Other: Lr a <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 L Bedroom(s)addition <br /> ❑ Other changes in land use involving potential sewage flow increase: <br /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC: S-39 rev: 8/10,04/12,03/18 <br />