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SIGNATURES ��oo r( <br /> leu l.� h (J1PC�,� <br /> CITY OF . <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> fdJ I b( orbi`u A1-, AAJ c.)0 3 S X17 a--tp /pc/ <br /> DATE ADDRESS TELEPHONE it <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 />