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5 . Will the project: <br /> a , generate objectional odors : L4,-, <br /> b. generate any discharge into surface waters : <br /> c . generate or store hazardous materials : v" <br /> d. expose people to any hazardous materials or situations : t.,,\ <br /> e . displace people : 44-4 <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 /> LJ Owner ' s legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> and <br /> that the foregoing is true and correct. <br /> �.! D 7 <br /> (Signature ) ( ate ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />