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A o <br /> SIGNATURES <br /> CITY OF ?Aire-0 PLANNING OFFICIAL: <br /> (Print ame) • fi"_ 2r^y_if _f',�.A:, ' <br /> h 1410r /., <br /> D OADI>ei b • 56/110 iwe, TELEPHONE# <br /> -11)9- K97- <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 />