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SIGNATURES <br /> CITY OF Q E`rb* PLANNING OFFICIAL: <br /> \A\e11 -\ eonnor <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> I (9-12-‘ . .&xs �1c � 5o7 -�S�-3yq�DAE ADDRESS OC\q,3L\'Z TELEPHONE# <br /> COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS TELEPHONE# <br /> a 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/!0,04/12 <br />