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.f <br /> SIGNATURES <br /> CITY OF Salem PLANNING OFFICIAL: <br /> Lydia Keller <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> 555 Liberty St SE, Suite 305, <br /> August 11, <br /> 3143 Salem OR 97301 503-540-2326 <br /> ADDRESS TELEPHONE# <br /> *COUNTY PLANNING OFFICIAL <br /> Daniel Jansen '�� J <br /> (Print Name) PLANNING OFFICIAL Signature <br /> 7/25/2023 5155 Silverton Rd NE, Salem 97305 503 588 5038 <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 />