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r <br /> ."4414'z''..,c- MARION COUNTY I3UILDING INSPECTION DIVLSION <br /> ----------,...,- <br /> -..--.-..-.---:---,-1--,-_,,-..-,-;-,.% <br /> '. „„,,, <br /> LI 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)5:4:-5147 <br /> Fax: (503)588-7948 <br /> _ _ ,. . <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON•SITE SEWAGE SYS'TEMS <br /> DATE: (.0b U I ?.eYa.-- Mail File#: <br /> -,.. <br /> SECTION 1—APPLICANT INFORMATION . <br /> I. Property Address: 7(.00 &fan:166) ,41e.-Property ID#: <br /> Scotb Alb 02 Q7375 <br /> Section:IZAC. Township: 063 Range: 0 I E Tax Lot#: <br /> bor500- <br /> 660 - <br /> 2. Name of Applicant: Berme,* ..5epti c.— Telephone#; -S29-41462 <br /> _ _ 3 <br /> Mailing Address: PC T)ok5O1 <br /> Mokxib. 0 K er-7 0 31 . <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> -pf Single Family Residence <br /> O Business <br /> O Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> O New Installation Permit <br /> CI Repair Permit <br /> U Alteration Permit for: 0 Replacement Dwelling Cl Bedroom(s)addition <br /> Other changes in land use involving potential sewage flow increase: <br /> 4e.,..4- pif---- <br /> G:IFORMS1SEPTIC1Application Packets\S-39 LUCS.dec MC:S-39 rev:SAO,04/12 <br />