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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: Ane Keohokalole Highway, Puohul hull St. to Manawalea St. Date: June 3, 2010 <br /> TMK No.: (3) 7- 4-021: 020 <br /> Applicant Information: Contractor information: <br /> Name: Race Randle Name: Alex Leonard <br /> Address: 5173 Nimitz Road, Honolulu, HI 96818 Address: 638 Laumaka Street, Honolulu, HI 96819 <br /> Company: Forest City Hawaii Kona, LLC Company: Nan inc. <br /> Phone No.: (808) 839-8771 Phone No.: (808) 842 -4929 <br /> Check applicable box: j Sewer Main Installation (Indicate reason for work and complete Parts 8 & C.) <br /> ❑ Sewer Lateral Installation (indicate reason for work and complete Part C) <br /> Reason For Work: The proposed sewer main extension would provide sewer service for the Kamakana Project within <br /> parcel 7- 4-021: 020. <br /> Part B. <br /> Sewer extensions are subject to HawaVI County Code, Section 21 -26 (Applications for Extensions) and Section 21 -28 <br /> (Payment of Construction Costs). 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. ❑ <br /> Section 21- 28(b)(1): County constructs, applicant pays. I ] <br /> Section 21- 28(b)(2): County constructs, applicant and County share cost. ❑ <br /> Estimated Start Date August 2010 Estimated Completion Date July 2011 <br /> Part C. <br /> 1 hereby certify that all work requested above will conform to appropriate sections of the Hawaii County Code. <br /> Owner Signature: _ Date: 6/ / 7 /b <br /> Department of Environmental Management, Wastewater Division <br /> Approved by: Date: L/ , b <br /> Wattewater ~vision Chief <br /> Approved by: 4A,- I Date: h/ t 1 'LOG O <br /> Director of Envimnme ifi 1 Management <br /> Note: 1) Applicant must submit a copy of the Sewer Extension Resolution and Coves Letter information along <br /> with this completed applcation to the Wastewater Division at the time of sewer plan submittal. <br /> 2) Filing of Sewer Extension Resolution is not required for sewer lateral instarations. <br /> Hawaii County is en Equal Opportunity Provider and Employer <br /> ATTACHMENT A 12/04 <br />