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SIGNATURES <br /> CITY OF -O I . M \ PLANNING OFFICIAL: <br /> cZob\Yl 1----"buoryN 1 f./{"" <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> I I )g IgoaLI Po BC dab Sca1h r4;1l3 c563)E -5'135 <br /> DATE ADDRESS g73'JS 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 />