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SIGNATURES <br /> CITY OF 1 PLANNING OFFICIAL: <br /> �.( S ` 5 l � %1// , <br /> (Print Name) PLANNING OFFI•I (Signa <br /> ,C) -c)R-L 7 -\.,3-21,9, L" <br /> D E ADDRESSate\--���7 <br /> q0349-1 TELEPHONE# <br /> *COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS TELEPHONE# <br /> *If necessary,depending upon city/county agreement on jurisc#ction 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 />