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• <br /> • <br /> . MARION COUNTY BUILDING INSPECTION DIVISION <br /> -_.�—%;1;• 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 /> • <br /> DATE: 6 - l 16 MCBI File#: • • <br /> • <br /> SECTION 1-APPLICANT INFORMATION <br /> • <br /> 1. Property Address: f W t 14Od./OA(J`Q_ Property ID#: <br /> 1. -lb ?CJanin.o`D� <br /> Section: Township: Range: Tax Lot#: I O • <br /> 2. Name of Applicant: JAV115‘ _ VQ ff)(10,u.,,eiZ Telephone#:szll_9a/-2 y 3 3 <br /> Mailing Address: ' P...C1,l�J ' t\rvcs ) ea' l olocu `d 1't 0 <br /> Q ? �vs-- <br /> 3. Describe type of facility the on-site sewage system will serve(business,residence or other): <br /> Ill Single Family Residence <br /> Cl 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 <br /> 0 Alteration Permit for: 0 Replacement Dwelling 0 Bedroom(s)addition <br /> ❑Other changes in land use involving potential sewage flaw increase: <br /> • <br /> G\FORMSISEPTICIS-34 LITCS.DOIX Rev:8/10,04/12,03/18 <br />