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5 . Will the project : <br /> a . generate objectional odors : No <br /> b. generate any discharge into surface waters : No <br /> c . generate or store hazardous materials: No <br /> d. expose people to any hazardous materials or situations : No <br /> e . displace people: No <br /> f . use significant�amounts -of energy or natural resources : No <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions : No <br /> O 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 /> UOwner ' s legal agent (attach proof of the owner 's consent to file <br /> the application ) , <br /> and t at the fore o"g is tr a and correct. <br /> 014 <br /> �..r <br /> 17 <br /> (Signature :� (Date ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />