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il <br /> ' MARION COUNTY BUILDING INSPECTION DIVISION-1a 1-b� <br /> m <br /> 5155 Silverton Rd NE �`�!�_ <br /> vEc <br /> """`� Salem OR 97305 i. <br /> (503) 588-5147 JAN 08 2021 <br /> Fax: (503) 588-7948 MARION COUNTY <br /> DUILDING INSPECTION <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> \.1 <br /> DATE: ( g-- I 1, �OZC) MCBI File#: <br /> 1 SECTION 1-APPLICANT INFORMATION <br /> 1. Property Address: 11 d( Cedu r. L.4-1_ Property ID#: <br /> Gai s ,I2 i731-t1,o <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: 1' I cal �6 4..-S+ Telephone#: 425 -- . 13 - &1 (oS <br /> Mailing Address: nq a - <br /> Gaf-es i op. q734te(, <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> ad Single Family Residence <br /> ❑ Business <br /> ❑ Other: EXPIRED <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 /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev:8/10,04/12 <br />