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MARION COUNTY BUILDING INSPECTION DIVIS1ON <br /> --= 5155 Silverton Rd NE <br /> INN 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 /> • <br /> DATE: ( E71 5 MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 2 <br /> 1. Property Address: v r/l.�r�i C ` Property ID#: <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: ;Lt:'Q t-.- . Telephone#: <br /> Mailing Address: <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> 12bSingle 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 /> epair Permit <br /> ❑ Alteration Permit for 0 Replacement Dwelling 0 Bedroom(s)addition <br /> ❑ Other changes in land use involving potential sewage flow increase: <br /> G:IFORMSLSEPTIC1Application Packet3\S-39 LUCS.doe MC:S-39 rev:11/10,04112 <br />