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I III <br /> :41t1Aft--- <br /> MARION COUNTY BUILDING INSPECTION DIVLSION <br /> -= r 5155 Silverton Rd NE <br /> A <br /> Salem OR 97305 <br /> 111 <br /> (503) 588-5147 • <br /> Fax: (503)5813-7948 <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: - Z 1- Z"t. MCBI File#: ZZ h '9/ 9 <br /> SECTION 1 APPLICANT INFORMATION <br /> 1. Property Address: 0(0 87 H4Afict Property ID#: <br /> oe- 7ot't <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant It:Vev.Oaw tuw.ki ti4y .canw+el" Telephone#: 5 d , (07 g-Z.7 a3 <br /> Mailing Address: F__'to t 3 c/ ' <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> ❑Single Family Residence <br /> C)Businessctit ff <br /> Other: iLe i pi+ <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> C]New Installation Permit <br /> C]Repair Permit <br /> Cl Alteration Permit for: C]Replacement Dwelling CI Bedroom(s)addition <br /> Other changes in land use involving potential sewage flow increase: 5i ‘ttli * -� <br /> mo pky$;coat 0...Incwvo40 &- IAA o-t .. +o /q.dd, in,. g PioC.l <br /> P"OP&vi-y ors bu.ad i v►g. <br /> O:IFORMS1SBFrIC\S-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />