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j-1 -.p 0666.7 <br /> Fi <br /> MARION COUNTY BUILDING INSPECTIOIfI SIGN <br /> 5155 Silverton Rd NE JAN 2 2021 <br /> Salem OR 97305 <br /> (503)588-5147 "`�t ff N COUNTY <br /> Fax: (503)588-7948 SUfLd�l1VU INSP�e7 foN <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: i J pD 51,90� ( MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: 131 Liu/5q_ S`" Property ID#: <br /> C ettes, O,*2A 3L( , <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: tXLrre( Bush Telephone#: <br /> Mailing Address: `�&.leIk (,I,Cj, Cz.14C • _. <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> 1st-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 /> Cl Alteration Permit for: SeReplacement Dwelling ❑ Bedroom(s)addition <br /> ❑ Other changes in land use involving potential sewage flow increase: <br /> G:\FORMS\SEPTIC\Application Packets\S-391.,UCS.doc MC:S-39 rev:8/10,04/12 <br />