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5 . Will the project: <br /> a . generate objectional odors : �U <br /> b. generate any discharge into surface waters : Afc) <br /> c . generate or store hazardous materials : <br /> d. expose people to any hazardous materials or situations : k10 <br /> e . displace people: 4V <br /> f . use significant amounts of energy or natural resources :2Y) <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions: U <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� 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 . f y <br /> (Si?�&ture ) ( (Date ) <br /> }- <br /> Y - <br /> fy. <br /> Minor Subdivision - 10 - ( 6/86 ) <br />