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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 : : o <br /> g. cause congestion on roadways or at interchanges or intersec- <br /> tions: No <br /> ❑ SIGNATURE <br /> I certify under penalty of perjury that I am (check one ) : <br /> X❑ Legal Property Owner (owner includes partner, trustee, trustor, or <br /> corporate officer . ) <br /> �--I Owner ' s legal agent (attach proof of the owner 's consent to file <br /> the application ) , <br /> and that the foregoing true and correct. <br /> t/ <br /> ARIL DEN HARTOG /(Date ) <br /> MARK VERNON HOLTHOUSE <br /> EMMA MAR LTHOUSE <br /> MARGARE C. HOLT1-IOUS- <br /> 3 <br /> E <br /> or Subdivision - 10 - ( 6/86 ) <br />