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5 . Will the project : <br /> a . generate objectional odors :_ Ny <br /> b. generate any discharge into surface waters : I(Jv <br /> C . generate or store hazardous materials : <br /> d. expose people to any hazardous materials or situations : Wd <br /> e . displace people : e , <br /> f . use significant amounts of energy or natural resources : • <br /> g. cause congestion on roadways or at interchanges or intersec- <br /> tions : Al�o <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 /> �--! 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 /> Minor Subdivision - 10 - ( 6/86 ) <br />