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-t t7 J \ \� <br /> • <br /> CEOVE ' <br /> MARION COUNTY BUILDING INSPECTIO 2 6 2017 -� <br /> -- " 5155 Silverton Rd NE <br /> Salem OR 97305 MARION BOUNTY\`S • <br /> (503) 588-5147 BUILDING I SPECTION <br /> Fax: (503)588-7948 <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: CO stXQ — 11 MCBI File#: <br /> SECTION 1-APPLICANT INFORMATION <br /> 1. Property Address: L\fkrst a t e4. Property ID#: <br /> rya oe <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: S EP.-- \C\C.. Telephone#: <br /> Mailing Address: e'O, gpy Sq y <br /> �IkAr 0C- <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> $$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 /> O Repair Permit <br /> O Alteration Permit for: 0 Replacement Dwelling 0 Bedroom(s)addition <br /> 0 Other changes in land use involving potential sewage flow increase: <br /> OVA(1- l O‘i eFYLS S cu 1 r\S�(, `\2() �n cl n eu eA-- <br /> us -c <br /> G:\PORMS\SEPTTC1Application Packets\S-39 LUCS.doc MC:S-39 rev:8/10,04/12 <br />