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' 6 <br /> SIGNATURES <br /> CITY OF Salem PLANNING OFFICIAL: <br /> Jacob Brown, Planner I <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> 10/17/2023 555 Liberty Street SE- Room 305 503-540-2347 <br /> DATE ADDRESS 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 /> GAFORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev: 8/10,04/12 <br />