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AR QYTY:.; 77. <br /> 1X. <br /> a >Nff <br /> --- -- <br /> Describe sir pollutants that may result Gan the project(mg,,coresuuaim related duet,vehicle trips per day,fireplace,incinerators,etc.): <br /> NONE <br /> Describe any hazardousmatariaLs/waves that will be present of-site: <br /> NONE <br /> OTHF <br /> Desmbe any ite ra.of histoid or archaeologic l interest on-site(e.g.,ce u t tea or structrrro): <br /> NONE <br /> Describe say on-site or off-site sources of roue or vibration(e.g..Goeway mix,heavy equiptnent, <br /> NONE <br /> Describe any ah-site or offsite s wrees of light or glare(e.g.,parking lot lighting or reflective materials used): <br /> NDIE <br /> I <br /> Descnbe any on-site or offsite source of odor(e.g.,agnccultuml wales): <br /> NONE <br /> Describe any displacernent of people that will be caused by the project(e.g.,numbers of people,housing units): <br /> NONE <br /> } ... �. ....04 3 f. ' <br /> Y Y�4 TtAMF pY ,r�SF{ <br /> ✓ i.niN.atf . ( OALI��!e+f+aYfL J . <br /> G! t YT (l�i NTL1HskPRY'ti R hN R} Y#�i�ttlT tC�TM tib E S7 TRMR k #7CR7ff)i1. <br /> SIGNATURE: 1 certify under penalty of perjury that I aro(check one): <br /> o Legal property owner(owner includes partner,trustee,trustor,or corporate olHeer)of the property(s)Involved <br /> W this appllcmtlo or <br />