COM 0543.001 2008-2010 - Laserfiche WebLink

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Department of Environmental Management Wastewater Division, County of Hawai'i Application For Sewer Extension Part A. (must be completed) Project Address: 605 W. Lanikaula St. to Leilani St. I Manono St. Intersection Date: April 23. 2009 TMK No.: (3) 2-4-056: 017 Applicant Information: Contractor Information: Name: Debra Fitzsimons. Vice Chancellor of Admin. Affairs Name: To Be Determined '"""'.-"l "'",' i *"'''::"''} Address: 200 W. Kawili St. Hilo. HI 96720 Address: '.c- .. ~ l-: ! r",,,,) Company: Universitv of Hawaii at Hilo Company: :n.-:: \) Phone No.: (808) 974-7595 Phone No.: '.__'->- L_ "':'"',::.~~ ~'-) ~'~ :~~; ..... c>.', Check applicable box: X Sewer Main Installation (Indicate reason for work and complete Parts B;i~ C.);: . ,: '\ -.,-. ~ Sewer Lateral Installation (Indicate reason for work and complete Pa~fC) ".0 Reason For Work: The proposed parallel Lanikaula St. sewer main will convey the additional wastewater flow due to the future expansion of the UH-Hilo campus within the parcels: 2-4-001: 007. 2-4-001: 041. 2-4- 001: 122.2-4-001: 169. and 2-4-056: 017. Part B. Sewer extensions are subject to Hawai'i County Code, Chapter 21, Division 4, Extensions and the APPLICANT shall be responsible for submittinq a resolution to the County Council for approval of the sewer main extension. Select one of the following methods of payment for cost and construction: (Note: reimbursement refers to payments collected by the County from properties connecting to the extension) Section 21-28(a): Applicant constructs and pays. X Section 21-28(b)(1): County constructs, applicant pays. Section 21-28(b)(2): County constructs, applicant and County share cost. Estimated Start Date Estimated Completion Date Part C. I hereby certify that all work requested above will confonn to appropriate sections of the Hawai'j County Code. Owner Signature: {)1../;&.)~.~ Date: (./F)/O; Department of Environmental Management, Wastewater Division Approved by: ~ ~ Wastewater Division Chief Date: rl r4 Approved by: Director of Environment Date: 7/30 to q Note: 1) Approval of the Application for Sewer Extension does NOT constitute approval for construction. Approval for construction is provided by an approved Penn it to Perfonn Work on the Public Sewer System pending final approval by the Hawai'i County Council in accordance with Section 21-26.1 of the Hawai'i County Code. 2) Filing of Sewer Extension Resolution is not required for sewer lateral installations. Attachment "A" (1)