Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503) 588-5147 <br /> Fax: (503) 588-7948 <br /> EXPIRED <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: I O- - Zv MCBI File #:2G �oa 7 92? - !4111-i <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: SZYScc‘ (-- woov lit Property ID#: <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: 5c otC ' ""4"' Cn42,4-._ Telephone#: 923-53Q—5 Vo 4 <br /> Mailing Address: o . do' RA-I'3 <br /> (act,\ 02 gi73(00 <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> lJtSingle 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 /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC: S-39 rev: 8/10,04/12 <br />