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5 . Will the project: <br /> a . generate objectional odors : X1(9 <br /> b. generate any discharge into surface waters : ho <br /> c . generate or store hazardous materials : <br /> d. expose people to any hazardous materials or situations: WO <br /> e . displace people: 110 <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 /> L---I Owner ' s legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> ae foregoing is true and correct . <br /> nd t t . <br /> A,?�_7"/ Z2 <br /> (S gnature ) Tom_ (D te ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />