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SIGNATURES <br /> CITY OF PLANNING OFFICIAL: <br /> (Print Name) LANNING OFFICIAL(Signature) <br /> DA E ADDRESS OQ Q-13 l 2 TELEPHONE <br /> *COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS TELEPHONE# <br /> */f necessary.depending upon city/county agreement on jurisdiction outside city limits but within UGB. <br /> ( <br /> G:\FORMSISEPTIC'Application Packets\S-39 LUCS.doc MC:S-39 rev: 8/10,04/12 <br />