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SIGNATURES <br /> CITY OF e ClaitS litktr� S PLANNING OFFICIAL: <br /> r <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> ti-425 Xw `-.a ),avoo-s-875-syss- <br /> DATE ADDRESS beo+1-% s,9 767S" 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 />