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SIGNATURES <br /> CITY OF,2Ci/G?%7 /iwU PLANNING OFFICIAL: <br /> Qtb-bv_i_A I(1/1qer <br /> (Print Name) PLANNING OFF CI (Signature) <br /> /&'ZZ Ill l vc/zz & ' 413-D 3?// <br /> DATE ADDRESS �C«t/i Q2 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 /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC: S-39 rev: 8/10,04/12 <br />