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\v/ <br /> SIGNATURES <br /> CITY OF 5;-i-et..j its.s(1. PLANNING OFFICIAL: <br /> A <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> -7) 6-1Q62744 (1 (] 3 (.. 4lre- 503 '7-69: <br /> PATE ADDRESS TELEPHONE 4 <br /> 4'COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE. ADDRESS - TELEPHONE B <br /> 2 ifnemssary.depending npon eilyenunor agreement on jukisdicaion outside citv Binds bui within UGB. <br /> GAFORMS\SEPTICApplieation Pac.ketskS-39 LUCS.doe MC:S-39 rev: 8/10,04/12 <br />