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5 . Will the project: <br /> a . generate objectional odors : �0 <br /> b. generate any discharge into surface waters : 1111"', <br /> c. generate or store hazardous materials: /L&II <br /> d. expose people to any hazardous materials or situations : 1,1,1' <br /> e . displace people: X;f <br /> f. use significant amounts of energy or natural resources: <br /> g. cause congestion on roadways 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 /> UOwner ' s legal agent (attach proof of the owner 's consent to file <br /> the application ) , <br /> and that the foregoin is true and correct. <br /> ( gna ure ) (Date ) <br /> i <br /> Minor Subdivision - 10 - (6/86 ) <br /> J <br />