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5 .' Will the project: <br /> a . generate ob jectional' cdors : <br /> b. generate any discharge into surface waters : (/ <br /> c . generate or store hazardous materials : <br /> d. expose people' to any hazardous maters-1- or situations : <br /> e. displace people: <br /> f . use significant amounts of energy or natural resources : <br /> g. cause congestion on road ys or at interchanges or intersec- <br /> tions: <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 /> 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 /> (S gnat r Mate() <br /> Minor Subdivision - 10 - ( 6/86 )- <br />