Laserfiche WebLink
r <br /> • <br /> SIGNATURES <br /> • <br /> CITY OF Salem PLANNING OFFICIAL: <br /> • <br /> Jacob Brownti1/41105:044eic....0 <br /> (Print Name) LANNING OFFICIAL(Signature) <br /> 555 Liberty St SE, Suite <br /> 8/1/2024 305, Salem, OR 97301 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\SEPTICIS-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />