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! H <br /> CEIIVE <br /> MARION COUNTY BUILDING INSPECTIO JU7d 2 6 2017 -J <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 MARION BOUNTY``S • <br /> (503) 588-5147 BUILDING IIISPECTION <br /> Fax: (503)588-7948 <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: Lp macs - 11 MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: 9.3S.C4AL-\n(M ISt eft, Property ID#: <br /> C3•a o� <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: S \(\C. Telephone#: <br /> Mailing Address: f.o. 04. sy <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> (Single Family Residence <br /> ❑ Business <br /> ❑ Other: <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 /> OV (- 1 O%.1 eAtt S \n S�f` .c) If\ct n eueA-- <br /> vs2.�. <br /> G:\FORMS\SEPTlOApplication Packets\S-39 LUCS.doc MC:S-39 rev:8/10,04/12 <br />