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State of Hawaii Wastewater <br /> Oepartmeni of Health <br /> Environmental Management Division Docket opl_-0C~ VYJW <br /> A__PPLICATION FOR VARIANCE -Effective December 9 2004 <br /> Wastewater Systems <br /> (In accordance with Chapter 342 D Hawaii Revised Statues) <br /> Submit two (2) (one original 8 one copy) and filing fee of $300.00 payable to State of Hawaii to: <br /> Hawaii State Department of Health <br /> Wastewater Branch <br /> 919 Ala Moans Blvd- Room 309 <br /> Honolulu, Hawaii 96814-4920 <br /> Ptt(808~586-4294 Fax (808)586-4300 <br /> Attachments are allowed, but preferred in 8'fz" x 11"format (for copying purposes). <br /> <br /> I. GENERAL INFORMATION (please print or type): <br /> A. Name: Hualalai Rlderly Housing Phave 9 Limited Partnership <br /> (Corporation, company, agency, firm, etc. seeking variance) <br /> 100 Pauahi Street 11204 <br /> Mailing address: <br /> Hilo Hawaii 96720 <br /> (City) (Island) (Zip code) <br /> Brief Description of Variance: <br /> Plant or Equipmern location: Tax Map Key n: ( 3 ) 75=10: 84 <br /> Divisions: 7-Oahu 2=Maui Big Islano 6-Kauai (Division) Zone - Sec - Plat Parcel <br /> 75-260 Hualalai Road <br /> (Number) (Street) <br /> Yailua-Vona, u~~~~aii QF,7Ln <br /> (City) (Island) (Zip code) <br /> B. Individual authorized to act for applicant: <br /> Name: Keith Kato Title: Executive Director <br /> Address: 100 Pauahi Street 11204 <br /> H}~ n ul Qr,77f1 <br /> (City) (Island) (ZIp code) <br /> Phone No.: 808-969-1158 x 105 Fax No.:808-935-6916 <br /> Email Address: kaith(dhirAr.org <br /> <br />