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SIGNATURES <br /> CITY OF " 1)2:10, PLANNING OFFICIAL: <br /> Ry.cun 110 n <br /> (Print Name) I G OFFICIAL(Signature) <br /> Seip 'q, 2.03 s55 L.1tr st ss (So3}5 4-0 -232G <br /> DATE ADDRESS TELEPHONE# <br /> • <br /> * COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> • <br /> DATE ADDRESS . TELEPHONE# <br /> *If necessary,depending upon city/county agreement on jurisdiction outside city limits but within UGB. <br /> • <br /> G:IFORMSISEPTIC IS-39 LUCS.DOCX Rev:8/10,04/12,03/18 <br />