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5 . Will the project : <br /> a . gent­, ate ate objectional odors : UnI nOW11 <br /> b. generate any discharge into surface waters : lhlknown <br /> C . generate or store hazardous materials : Unlmown <br /> d. expose people to any hazardous materials or situations : �o <br /> e . displace people : Nn <br /> f . use significant amounts of energy or natural resources : No <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions : Nin <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 /> uOwner ' 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 ) (Dz.:e ) <br /> 1NTELDO\ MOSS <br /> 1VAYN . RA (Date) <br /> Major Subdivision - 10 - (6/86 ) <br />