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SIGNATURES <br /> CITY OF 1J-�M PLANNING OFFICIAL: <br /> M C' . CCMCW ‘ a <br /> (Print Name) LANNING OFFICIAL(Signature) <br /> 1(�(2\ �,�.�0-A 5Sq rai 5U3-S,Sy-'3`1�1�,0 <br /> DATE ADDRESS OQ�Q--1 2 TELEPHONE# <br /> * COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS TELEPHONE# <br /> • <br /> *If necessary,depending upon city/county agreement on jurisdiction outside city limits but within UGB. <br /> if <br /> MC:S-39 rev: g/10 <br /> G:�'ORMSISEPTIC1Application Packets\S-39 LUCS.doc ,04/12 <br />