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—O OaFr44 <br /> MARION COUNTY BUILDING INSPECTIOtiSibl� - E Th <br /> 5155 Silverton Rd NE <br /> 1.1111 Salem OR 97305 <br /> JAN 12 2021 <br /> (503) 588-5147 <br /> Fax: (503) 588-7948 MARION COUNTY <br /> BUILDING INSPECTION <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: 111181�6 MCBI File#: <br /> SECTION 1 —APPLICANT INFORMATION <br /> 1. Property Address: 5b L 17 " v.)006 Di Property ID#: <br /> e0A-cs on- T7311(c- 05563EW. c400203 <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: -onk tA&A /jahei4 C r.14Co' Telephone#: <br /> Mailing Address: )S 1 b 0.A.6 Qc u< St: <br /> ga\-eA- 02 97 317 <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 /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev: 8/10,04/12 <br />