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SIGNATURES <br /> CITY OF , • II PLANNING OFFICIAL: <br /> .JG1�C9� &/6-1/?11-r(i'NOjr �� <br /> (Print Name) 9.(14PLANNING I FILIAL gnature) <br /> 11- 7- i3 So6 i cue - 50) - es?7c[•-v&it <br /> DATE ADDRESS S.I ve f+o,l ( a 7 3 f( 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\Application Packets\S-39 LUCS.doc MC:S-39 rev: 8/10,04/12 <br />