Laserfiche WebLink
SIGNATURES <br /> ��, ,2o6aes,� n►�V �a ! i 111, <br /> CITY OF (4 Uv� .,5 PLANNING OFFICIAL: <br /> (Print Name) A (Signature) <br /> G+4i Ort1Q4e- <br /> �1 •.›'g?-baa 10 l 5orh(A >4ve.u/ fts <br /> / _ 3 897 ace(e7 <br /> DATE ADDRESS /'at-(s1 Dip 1134 to <br /> TELEPHONE# <br /> * COUNTY PLANNING OFFICIAL <br /> A � <br /> S+h 5ct r he s <br /> (Print Name) PLANNING OFFICI (Signature) <br /> 111z312-C2-0 5 155 S; II,cri i Rd So3— — 0034 \)1 <br /> DATE ADDRESS TELEPHONE# <br /> *it 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 />