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04/01/2019 04:44PM 5038543232 CITY OF DETROIT OR PAGE 01!03 <br /> • RECEIVED 04/01/2019 12:44PM 5038543232 CITY OF DE-T OIT OR <br /> =_.,_ _ • MARION cOUNXT BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> Sele,1n Oft 97305 <br /> (503)588-5147 <br /> FRX: (5O3)505.7948 <br /> TSA, TUSE COMPATIBILITY STATE NT(LUCS) <br /> • FOR ON-SITE SEWAGE SYSTEMS <br /> DATE: Y ! rCBI Pile#: • <br /> s j oN i»-APPLICANT DIFoRM TION <br /> 1. Property Address:ire2_areSMALte,12roperty TD#: <br /> 114.ki ;LI <br /> Section: <br /> Township:��. Xenget Tax Lot#: <br /> 102 <br /> 2. Name of Applicant: w Sreieplxoue#: 0:221 . 47 <br /> Mailing Address: 1 • <br /> 117111FEMNEM <br /> 3, Describe type of Ibelfacility the at-site sewage system will serve(business,residence or other): <br /> Single Family Residence <br /> ca Business <br /> El Other: <br /> 4, Type of on-site sewage system permit application being proposed for this property: <br /> CI New Installation Permit <br /> U Repair wart <br /> © Alteration Permit for: ephacementDwelling ❑ Bedroom(s)addition <br /> ❑ Other changes in led use involving potential sewage flow increase: <br /> £;_Fonms\Slzlincupplicatioa l'ackets15r391,'CTCp.daa • MC:S-39 t v:$/1O 04/12 <br />