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5 . Will the project: <br /> a . generate objectional odors : /P <br /> b. generate any discharge into surface waters : <br /> c . generate or store hazardous materials: C <br /> d. expose people to an hazardous materials or situations : is <br /> e . displace people: <br /> f . use significant amounts of energy or natural resources :_ /d <br /> g. cause congestion on roadways or at interchanges or intersec- <br /> tions : �n <br /> ❑ SIGNATURE <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 /> u Owner ' s legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> and that the foregoing is true and correct. <br /> (Signature ) (Date ) <br /> • Z� • �'7 ArrLic,#4�TIcw GTL SI&wA v2IEx <br /> Minor Subdivision - 10 - ( 6/86 ) <br />