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5 . Will the project: <br /> a . generate objectional odors : A10 <br /> b. generate any discharge into surface waters : /t/Q <br /> C . generate or store hazardous materials: <br /> d. expose people to any hazardous materials or situations : �V(� <br /> e . displace people: N <br /> f . use significant amounts of energy or natural resources : /y , . <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions: /V0 -. <br /> ❑ SIGNATURE -_ <br /> i certify under penalty of perjury that I am (check one ) : <br /> Legal Property Owner (owner includes partner, trustee, crusta?- , <br /> corporate officer . ) <br /> LJ Owner ' s legal agent (attach proof of the owner ' s consent `o I`iA1 <br /> the application ) , <br /> and that the foregoing is true and correct . <br /> (SigAtature ) (Date ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />