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Department of Environmental Management <br />Wastewater Division, County of Hawai'i <br />Application For Sewer Extension <br />Part A. (must be completed) <br />Project Address: 77 -AM Drive <br />TMK No-- (3) 7-7-004 : 057, 068 <br />Applicant Information: <br />Date: 04 September 2020 <br />Contractor Information: <br />Name: Larry R. Smith Name: SAME <br />I <br />Address: 77-63493 Alil Drive. K2ilug-Kona, HI 96740 Address: <br />Company: Royal AM LL <br />9= <br />Phone No.: 80&937-2300 Phone No.,, <br />Check applicable box: Sewer Main Installation flndicate reason for work and complete Parts 8 � C.) 9A!,10< <br />Sewer Lateral Imtallation (indicate reason for work and complete Part C) <br />TAkv -1 <br />Reason For Work; Provide sewer for 19 new tots created � Planned. Use Deveipment (PUD -05-005 <br />REF: SUB NO -07-000602, SMA 05-007 <br />Part B. <br />Sewer extensions are subject to HawaVi County Code, Chapter 21, Division 4, Extensions. The APPLICANT shallbe <br />Select one of the following methods of payment for cost and construction: <br />(Note: reimbursement refers to payments collected by the County from properties connecting to the extension) <br />Section 21-28(a): Applicant constructs and pays. 01 <br />Section 21-28(b)(1): County constructs, applicant pays; 0 <br />Section 2148(b)(2): County constructs, applicant and County share cost, 0 <br />Estimated Start Date Estimated Completion Date <br />Part C. <br />I hereby certify tha all w*rk reques ve evil) co Corm to appropriate sections of the HawaH County Code. <br />`ta fio-,i P <br />owner Signature:Date: 04 September 2020 <br />Department a Environmental Management, Wastewater Division <br />Approved Date: <br />Wastewater Divis' Chief <br />Approved by: Date'... <br />------ - T� — A�J�y <br />15fr—eatorrdf lt-n- men-ta-.1 Management <br />Note: 1) Approval of the Applicafion for Sewer Extension does NOT constitute approval for construction. <br />Approval for construction is provided by an aooroved Permit to Perform Work an the Public Sewer <br />System pending final approval by the Hawal'! County Council in accordance with Section 21-26.1 of the <br />Hawa(1 County Code., <br />2) Filing of Sewer ESL:tension Resolution is not required for sewer 14teral installations. <br />pawaii Countyis ao. Sava]. Opportunity Pfrtwdar 9,nd J;Mplcyor <br />Exhibit A <br />