Laserfiche WebLink
• <br /> MARION COUNTY BUILDING INSPECTION DIVISION <br /> _ 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)588-5147 <br /> Fax: (503)588-7948 <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: k- 1-AQa-\ MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: \CS \`C S\: 13 Property ID#: 1p5 a A\ oe Sin <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: 1 bgroail <br /> Telephone#: 50.6 2?1- <br /> Mailing Address: ? jY StA (9 0.I(3 <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> II Single Family Residence <br /> ❑ Business <br /> O Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> ❑ New Installation Permit <br /> Ar Repair Permit teo 7C rticdur <br /> O Alteration Permit for: 0 Replacement Dwelling ❑ Bedroom(s)addition <br /> O 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 />