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MARION COUNTY BUILDING INSPECTItiN DIVISION <br /> 5155 Silverton Rd NE <br /> maw <br /> ..................--, Salem OR 97305 <br /> (503)588-5147 <br /> Fax:(503)5813-7948 <br /> - , <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: It/1110 MCI31 File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> I Property Address: St 4)17 t'.**"*"'44.0 Pf Property II)It: <br /> eakt 41,s Om ci)34141 0 i 5t) 3 E (0 c.A o 0 ao3 <br /> section: Township: Itange Lax Lot tt: <br /> ......__ <br /> 2- Name of Applicant: $14olit AbAterkwil&'.‘si 're ieptione II: <br /> Mailing Address: ;Sils 14.441 'tat if. <br /> ed. 17317 <br /> 3. Describe type of facility the on-sde sewage system will save(business,residence or other): <br /> la Single Family Residence <br /> U Business <br /> O Met ...... <br /> I <br /> 4 Type of on-site sewage system permit application being proposed dx dos property: <br /> U New lostnilation Permit <br /> 13 Repair Permit <br /> Cl Alteration Permit for lt1 Replacement Dwelling U Bedroom(*)eldkica <br /> U (him'changes in land use involving potential sewage flow 1111411111111K <br /> (i'i 4 JRMAS111110Appluons Poelotc&449 LUCS doe MC;949 roc 11/10.04111 <br /> , . „ <br />