Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION DIVISION <br /> ---%�"��"`:• 5155 Silverton Rd NE <br /> 1111111 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: I O- - 2-v MCBI File#:7° '4 0 712? ' '�v <br /> SECTION 1 -APPLICANT INFORMATION <br /> 1. Property Address: a)51..D. 1—krfm,.100 ThL Property ID#: <br /> R 02 <br /> Section: Township: Range: EX P J <br /> g <br /> E D <br /> 2. Name of Applicant: jC,otC, „) con4z.4 _ Telephone#: 9)2-5"3a- 5 Vo y <br /> Mailing Address: 0 . o NC <br /> Cfl 1 7.7(00 <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> C4Single 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 /> .Q, g424) G n.` <br /> r•Q_ 4114 - r Q <br /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC: S-39 rev: 8/10,04/12 <br /> I _ <br />