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MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> 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: it Jifrt MCII Fite H: <br /> SECTION l—APPLICANT INFORMATION <br /> lPmpesty Address: 13I7 i..- .wt cod Di Property ID <br /> ea tit, on- 97344, .._ oq 56 3E (i1 Roaoa <br /> section: Township: Range: TeaLiata>F <br /> 2, Name of Applicant: :1,44c16,_,,,,Mtk Tekphone <br /> Maihrsg Addmm. : 4/C14 6` 44 "tut i <br /> 1/41•-*Vgiv. e R 17 31'7 <br /> 3. Describe type of facility the on-site sewage system will serve(bwiium,resitknee or whet <br /> 101 Single Fatuity Residence <br /> U Dustmen <br /> U Otter, <br /> 4. Type of on-site sews>;. system permit appiie.al m being proposed for this prupetty: <br /> O New Installation Permit <br /> O Repair Pcrmmut <br /> U Alteration Permit for: it Replacement Dwelling U Iiedrnomn(tl)arklition <br /> U Other change*in laud use involving potential sewage flow wreak: <br /> St` ortMi iriEtttlAppt shire 14 1Ea+a 149 LUCZAK MC:$49 etc WIO,0012 <br /> -sue" <br />