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! S „ Will the project: NO TO EACH QUESTION <br /> it <br /> a . generate objectional odors : No II <br /> b. generate any discharge into surface water s-T-90- <br /> C. generate or store hazardous materials : NO <br /> d. expose people to any hazardous materials or situations : NolIlI <br /> . <br /> e . displace people : NO <br /> f . use significant amounts of ever i <br /> gy ar natural resources,: NO <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions: NO <br /> L <br /> ❑ SIGNATURE � <br />� II <br /> I certify under penalty of perjury that I am (check one ) : <br /> Legal Property Owner (owner includes partner, trustee, trustor, or <br /> corporate officer . ) <br /> f <br /> Owner ' s legal agent (attach proof of the owner 's consent to file <br /> the application ) , <br /> and th t 'the foreg ng is true and correct . J <br /> (Signature ) <br /> (Date ) <br /> i <br /> i <br /> I <br /> i <br /> II <br /> II <br /> �i <br /> I� <br /> �I <br /> i <br /> Use Permit Application - to ( 6/86 ) <br /> II <br />