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5 . Will the project : <br /> a . generate objectional odors : ITC) <br /> b. generate any discharge into surface waters : --- - __ <br /> C . generate or store hazardous material s : <br /> d. expose people to any hazardous materials_ or situations : _�--'- <br /> e . displace people : . N __ <br /> f . use significant amounts of energy or natural resources : - _ <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions : t�0 <br /> ❑ SIGNATURE <br /> I certify under. penalty of perjury that I am (check one ) : <br /> Legal Property Owner (owner includes partner , trustee , trustor , of <br /> 'corporate officer . ) <br /> Owner ' s legal agent (attach proof of the owner ' s consent to fii.e <br /> the application ) , <br /> and that the foregoing i5 true and correct . . <br /> (Signature j ( Date ) <br /> S,T. F-ANCB VtNEYA{zD <br /> -.-cam,- -- <br /> Minor subdivision - 10 <br />