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SIGN <br /> ATURES <br /> CITY OF 6Gt4 PLANNING OFFICIAL: <br /> (Print Name) P G OFFICIAL(Si attire) <br /> bl Soriad� AuiiI 5b3 g J7 i-Let 7 • <br /> DATE ADI6E� . / 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 /> • G:\FORMS\SEPTICIS-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />