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ai '"'uuuc <br /> MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503) 588-5147 <br /> Fax: (503) 588-7948 <br /> LAND USE COMPATIBILITY STATEMENT (LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: 11 Cj I U l'I MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: 7 to d �rC' 1 C U t-e- - 1 Property ID#: <br /> 5coIlS ?.At-1t 0gG7376 <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: B. i 1^-e-'\ C�u C 0-VCAlil Telephone#: 5(15 7 U 3- )3 <br /> 4-3 <br /> Mailing Address: 1p et ;-1-Le (1-6 Sg <br /> vay e.r Oft q--73 <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> L$ Single Family Residence <br /> ❑ Business <br /> ❑ Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> 0:1 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 />