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SIGNATURES <br /> CITY OF ( 7&r&S PLANNING OFFICIAL• <br /> c <br /> C, <br /> (Print Name) ANNING OFFICIAL(Signature) <br /> -114 c j f D( j cAl 503 V'1 7>te(a <br /> DATE ApD SS (OT2 417 341 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\SEPTIC\S-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />