Laserfiche WebLink
02 14,75-zD5VD <br /> EGENED <br /> JUL 112024 <br /> MARION COUNTY BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> 11111 Salem OR 97305 <br /> (503)588-5147 <br /> Fax: (503)588-7948 • <br /> LAND USE COMPATIBILITY STATEMENT(LUCS) <br /> FOR ON-SHE SEWAGE SYSTEMS <br /> DATE: -3- MCBI File#: <br /> SECTION 1-APPLICANT INFORMATION <br /> 1. Property Address: /S!o w -L Property ID#: 5 34 'CX <br /> S Fa.y . i ett a2-73 <br /> Section: e3Township: I a./ Range: 1ISh Tax Lot#: (W. <br /> 2. Name of Applicant: afseff.4. 9‘--Prgibt LLG Telephone#: $G3-3r.Z-0e1 <br /> Mailing Address: ' b3 /Lc IZZ. <br /> • Si*[or.,- fog_ 1-?aW <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> %Single Family Residence <br /> 0 Business <br /> ❑Other. <br /> • <br /> 4. Type of on-site sewage system permit application being proposed for this property: <br /> ❑New Installation Permit <br /> ,Repair Permit — Sy62<;-- <br /> 0 Alteration Permit for. 0 Replacement Dwelling 0 Bedroom(s)addition <br /> ❑Other changes in land use involving potential sewage flow increase: <br /> . 0:IFORMSMSEP11C S-39 LUCS.DOCC Rev:8/10,04/12,03/18 <br />