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SIGNATURES <br /> CITY OF V\CQO V)U( PLANNING OFFICIAL; <br /> t \ '\ <br /> • (Print Name FL G O IAL-(Signature) <br /> (Neil {'elta El' l E#q —)31 <br /> DA ADDRESS <br /> *COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS . TELEPHONE# ' <br /> *If necessary,depending upon city/county agreement an jurisdiction outside city limits but within UGB. <br /> • <br /> GAFORMS\SEPTICIS•39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />