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31-k-*C5bUD19-9 <br /> • RECE I EI <br /> °'' 4;„„,,, MARION COUNTY BUILDING INSPECTION DIVISION AUG 02 2OZ4 <br /> 5155 Silverton Rd NE. <br /> Salem OR 97305 <br /> (503)588-5147 <br /> Fax: (503)_588-7948 <br /> • <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: -7-3 l-ay MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: �✓17 S 1r 4�F(u f�� StE Property ID#: j 119 v--3 Co <br /> s«cf., a✓Lei'2 3Fs( <br /> Section: S' Township: 2A)Range: it/ Tax Lot#: <br /> 2. Name of Applicant: Ovr�.-` ��..�,,o-P �•1..t.« Telephone#: —kW—flay <br /> Mailing Address: Pe) iscx (7 <br /> ova 4173g1 <br /> 3'. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> ❑Single Family Residence <br /> At Business <br /> ❑Other: <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> IA New Installation Permit — <br /> ❑Repair Permit <br /> ❑Alteration Permit for: 0 Replacement Dwelling ❑Bedroom(s)addition <br /> ❑Other changes in land use involving potential sewage flow increase: <br /> G:IFORMSISEPTICIS-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />