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• <br /> MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5155 Sitveytag:RdNE <br /> Salem OR 97305 <br /> (505)508-507 <br /> Fax:'(503)5S8794:3 <br /> • <br /> LAND USE.COMPATIBILITY STATEIVLENT(LITCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> zz, 0 — / <br /> DATE; 05 I,gsio: . mptli Fite 0 c( 4 ,emr <br /> SECTION 1—APPLICANT INFORMATION <br /> 1.. Pit Terty Address:1140 S..'Bto.rv-s 'Ferry Rd. PtOperty.ID# <br /> INP(561*,rni OR 9110-7nt <br /> Section: CF-,5 Township: Rogw 19 R Tax Lotik,.00900: <br /> c.).• -1 cp-nn <br /> 2.: Name of Applicant Arnencary Oh 01-rc,Thkp1oue#. T 7ob3 <br /> .MailingAddss Mg k_)\I C:g.t/7ia <br /> • • <br /> Malal la OR 910 <br /> .3:. Describe qfpo ofroility trio or-site, ewagayaern wiltsorye.(buain04,:feaideoet ors-ot4er.); <br /> Singie FamilyResidence <br /> • <br /> Flpsiness <br /> C3,:Othef: . <br /> 4. Type oforifsitesewagasystein permit application'bingpropoagcl..for t1i proporty: <br /> • New Installation,Permit <br /> • <br /> Repair Permit <br /> Alteration:Penni(for: 0 Replacement Dwelling. 0 Bedroom ;addition <br /> O Otber.ehmo$:41 lend.pae hWoIvhgp.otential sewage flow inoras.e.:. <br /> GAFORMSSEPTECVtp04:4vion,P,ackcsN.441p LI:MS.(10 MC:S.-39 iti":'8/10,.04/12 <br /> -Ma 7 a 202.7 <br />