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e on tfvreto <br /> SIGNATURES'' <br /> CITY OF 4, PLANNING OFFICIAL: <br /> _re/J.4 Arv- <br /> m <br /> (Print:Name) PLANNING OF•ICIAL(Signature <br /> iLl 1 CA .55rbtrel e. ° 3" 811- 10/ <br /> DA'q �ID teeS 6 TELEPHONE <br /> *COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS TELEPHONE <br /> *Ifnecessary,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 />