Laserfiche WebLink
... 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: 62 - 3 - 2 1 MCBI File#: <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: 1 ) 'P L 3 4 Property ID#: <br /> ;(L$ , On t173t/6 <br /> Section: 2 G L S Township: 0 cJ Range: 3 k Tax Lot#: <br /> 7 b <br /> 2. Name of Applicant: 140 CO"le- L X C.c oe ih Telephone#: 5 O 3- C,! 32- 0 'IS y <br /> Mailing Address: (3 Z i` y L V►.c,14 GAS <br /> , 6R 47317 <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> J Single 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 /> 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 />