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A ■ <br /> VJ St Cy r.4 At, <br /> SIGNATURES <br /> CITY OF GPLANNING OFFICIAL: <br /> Archer- <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> tot dor 10 yetVe Ili 3 3 877 c949(o9 <br /> DjAt—lal ADDRESS TELEPHONE# <br /> COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS TELEPHONE II <br /> *If necessary,depending upon city/county agreement on jurisdiction outside city limits but within UGB. <br /> G:IFORMSISEPTIC1Application Packets\S-39 LUCS.doc MC:S-39 rev: 8/10,04/12 <br />