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5 . Will the project: <br /> a. generate objectional odors : No <br /> b. generate any discharge into surface waters : No -- -- - <br /> c. generate or store hazardous materials: No <br /> d. expose people to any hazardous materials or situations: No <br /> e. displace people: No <br /> f . use significant amounts of energy or natural resources : N„ <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 /> L ! = 0 ner ' s legal agent (attach proof of the owner 's consent to file <br /> e application) , <br /> a the foregoing is true and correct. <br /> (Signature ) (Date ) <br /> �J A,7 A4 c,-tAL A4c,^sr /nl �srs <br /> Minor Subdivision - 10 - ( 6/86 ) <br />