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SIGNATURES <br /> CITY OF 5C0 k PLANNING OFFICIAL: <br /> 1n �V.�JYlP2� <br /> (Print Name) P ANNING OFFICIAL(Signature) <br /> 10b4216 .0 ab5 �l Scat} )'i 11s S "3-&73-.5(43S <br /> DATE ADDRESS 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 />