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