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• <br /> 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: I r7 \ MCBI File#: / 02/74:7 / f <br /> SECTION 1—APPLICANT INFORMATION <br /> 1. Property Address: I 0 5 M e(9 ac 't CI- Property ID#: <br /> Ike+r Vi oR 973Y1 <br /> Section: Township: Range: Tax Lot#: <br /> 2. Name of Applicant: (favid, Gel kr Telephone#: 97 I- X 39- 88 25 <br /> Mailing Address: q 1.S Pipe Jurrf 1-1A NE <br /> k-e,2er, ora .9730? <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> 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 />