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SIGNATURES <br /> CITY OF t�Oui 11 c1 PLANNING OFFICIAL: <br /> 12,t bee a SI-norne v 'peg <br /> (Print Name) PL G OFFICIAL(Signa re) <br /> a97/ 23 PO,66v to6 -S �H f 3 <br /> D TE ADDRESS 47.35-6 TELEPHONE# <br /> * COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS . TELEPHONE# • <br /> *If necessary, depending upon city/county agreement on jurisdiction outside city limits but within UGB. <br /> • <br /> G:IFORMS\SEPTIC\S-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />