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SIGNATURES <br /> CITY OF l' U.e-5 PLANNING OFFICIAL: <br /> AK-kr-V- <br /> (Print Name) C (Signature) <br /> ord Q�- <br /> f� 4> ?0 Sorizt n A(/ 1.V �'a 3 897 <br /> DATE ADDRESS G at(S`,D,p p73,1 , TELEPHONE# <br /> * COUNTY PLANNING OFFICIAL <br /> Soh �unces <br /> (Print Name) PLANNING OFFIC (Signature) <br /> )/13121° 5 15 S; Lerbh Rd So3- <br /> DATE ADDRESS TELEPHONE# <br /> *If necessary.depending upon city/county agreement on jurisdiction outside city limits but within UGB. <br /> EXPIRED <br /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev: 8/10,04/12 <br />