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SIGNATURES <br /> CITY OFrc;\ PLANNING OFFICIAL: <br /> Ar.‘,%1/ Ck\,Wa\)•,—_ <br /> (Print Name), PLANNING OFFICIAL(Signature) <br /> 5121 • P.b . 2q, <br /> DATE' ADDRESS cc/ 642_ TELEPHONE# <br /> *COUNTY"PLANNING OFFICIAL - <br /> (Print Name) PLANNING OFFICIAL(Signature)- <br /> DATE ADDRESS TELEPHONE# <br /> *If necessray,depending upon city/county agreement on juris diction.outside:city limits but thin UGB <br /> G:WORMS\SEPTIC1App}icatioa'Packets\S-39'LUCS,doc. MC:S-39 rev:. 81i0,.04/12 <br />