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5 .- 'Will the project: <br /> a . generate objectional odors : <br /> b. generate any discharge into surface waters : No <br /> C . generate or store hazardous materials : , <br /> go <br /> d . expose people to any hazardous materials or situations :__tLo <br /> e . displace people : TI, <br /> f . use significant amounts of energy or natural resources : ?�o <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions : <br /> 4 <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 /> t--i 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 /> STi,-c:vC CofDAN \ <br /> tF <br /> Use Permit Application - 10 - (6/86) <br />