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SIGNATURES <br /> CITY OF c(�\ PLANNING OFFICIAL: <br /> .S\re—\\ _\,\Z_ M\f\CA( S -k\,\\— <br /> (Prin Name) ANNING OFFICIAL(Signature) <br /> 41 �� X 5 P\ C6\ \3 SO S LUc1 <br /> DAT ADDRESS c.), 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 />