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SIGNATURES <br /> CITY OF 1-�Xcp\\— PLANNING OFFICIAL: <br /> C\' 'MOB <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> \ 2\ () 1\ re\ t `5b3 531S`-\3ARb <br /> DATE ADDRESS R—l�y 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 />