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ECEnV <br /> MARION COUNTY BUILDING INSPECTION DIVISION JAN 14 2021 <br /> 5155 Silverton Rd NE MARION COUNTY <br /> Salem OR 97305(503)588-5147 BUILDING INSPECTION <br /> Fax: (503)588-7948 <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: 1 - f O -\ MCBI File#: 115 ZI "Uvoq()Li <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: a � VIp�� Property ID#: \DS E,CD\ p�, \i y(0 <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: Vie,\ gi p,\ Telephone#: <br /> Mailing Address: %16/ S \ Q&jLtQ VAP4N leA ,COYV\. <br /> 1 ucy'e 0Q_ Cl la <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> Single Family Residence <br /> EN) Business <br /> O Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> ❑ New Installation Permit <br /> Repair Permit 2C00..02 QiAur 0{\^TOvAr-- <br /> ❑ Alteration Permit for: ❑ Replacement Dwelling O Bedroom(s)addition <br /> 0 Other changes in land use involving potential sewage flow increase: <br /> G:\FORMS\S£PTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev:8/10,04/12 <br />