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Department of Environmental Management EXHIBIT A <br />Wastewater Division, County of Hawai'i <br />Application For Sewer Extension <br />Part A. (must be completed) <br />Project Address: 238 Belt Road, Hilo, Hawaii Date: October 17, 2024 <br />TMK No.: (3) 2-6-015:001 and 002 <br />Applicant Information: Contractor Information: <br />Name: Hawaiian Ola Brewing Corporation Name: To Be Determined <br />Address: 74-5598 Luhia St, Kailua-Kona HI 96740 Address: <br />Company: <br />Company: <br />Phone No,:. 808-646-1654, Brett Jacobson Phone No.: <br />Check applicable box: V Sewer Main Installation (Indicate reason for work and complete Parts B & C.) <br />EZ Sewer Lateral Installation (Indicate reason for work and complete Part C) <br />Reason For Work: 16 connect distillery, restaurant and bar to County wastewater system. <br />Sewer extensions are subject to Hawai'i County Code, Chapter 21, Division 4, Extensions and the APPLICANT shall be <br />responsible for submitting a final resolution to the Wastewater Division for review, The Department of Environmental <br />Management will submit the final resolution and supporting documents to the County Council for approval of the Sewer <br />main extension. 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, IK <br />Section 21-28(b)(1): County constructs, applicant pays. D <br />Section 21-28(b)(2): County constructs, applicant and County share cost. ❑ <br />Estimated Start Date - Upon approval of plans by Estimated Completion Date 9 to 12 months after contract award. <br />DOT and DEM. <br />Part C. <br />I hereby certify that all wori,,WWs ed above will conform to appropriate sections of the Hawal'! County Code. <br />HAWA11KN,0VLAB W RPOR ON <br />Owner Signature: Date: 101(712_02-� <br />BY: <br />j�C`OBSON, CEO <br />Department of Environmental Management, Wastewater Division <br />Approved by: NJ <br />Approved by: <br />Director of <br />ief <br />I Management <br />Date: <br />Date:, I D - I � - I It <br />Note: 1) Approval of the Application for Sewer Extension does NOT constitute approval for construction. <br />Approval for construction is provided by an approved Permit to Perform Work on the Public Sewer <br />System pending final approval by the Hawaii County Council In accordance with Section 21-26,11 of the <br />Hawai'i County Code. <br />2) Filing of Sewer Extension Resolution Is not required for sewer lateral installations, <br />Hawai'i County Is an Equal Opportunity Provider and Employer <br />M;\Wastewater\Plan Review\Sewer Extension Application.doc <br />