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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(approximately 4180 ft north of Date: February 19,2013 <br /> Palani Road and Ane Keohokalole Highway Intersection <br /> TMK No.: (3)7-4-021:026, 035, 036,037, 038,039, 040,044 <br /> Applicant Information: Contractor Information: <br /> Name: Mr.Jon Wallenstrom Name: Mr. Stephen Bartholomew <br /> 5173 Nimitz Rd. P.O. Box 383729 <br /> Address: Honolulu, HI 96818 Address: Waikoloa, HI 96783 <br /> Company: Forest City Hawaii Kona, LLC Company: Goodfellow Bros. Inc. <br /> Phone No.: (808)839-8768 Phone No.: (808)930-1090 <br /> Check applicable box: el Sewer Main Installation (Indicate reason for work and complete Parts B & C.) <br /> © Sewer Lateral Installation (Indicate reason for work and complete Part C) <br /> Reason For Work: Sewer mains and laterals being installed as part of the site development of Phase 1A of the <br /> Kamakana Villages of Keahuolu (Master Development)to collect and convey wastewater flows <br /> from the subject subdivision to the Kealakehe Wastewater Treatment Plant(via connection to the <br /> existing sewer main within Ane Keohokalole Highway). <br /> Part B. <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 resolution to the County Council for approval of the sewer main extension. Select one of <br /> 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. ❑ <br /> Section 21-28(b)(2): County constructs, applicant and County share cost. ❑ <br /> Estimated Start Date October 31,2012 Estimated Completion Date March 31, 2013 <br /> Part C. <br /> I hereby certif work re•uested a••ve will conform to appropriate sections of the Hawaii County Code. <br /> Owner Signature: Ir' , ,i Date: 7. fici <br /> I <br /> Department of Environmental Management, Wastewater Division <br /> Approved by: Date: 211-4/1-3 <br /> Wastewater Division Chief <br /> Approved by: Z l�/ii%t� 3.6 Date: :2) <br /> Dir or of Environmen al Management <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 Hawai'i County Council in accordance with Section 21-26.1 of the <br /> Hawai'i County Code. <br /> 2) Filing of Sewer Extension Resolution is not required for sewer lateral installations. <br /> Hawaii County is an Equal Opportunity Provider and Employer <br /> O:AWastewater\FORMS\070202 Sewer Extension Application-Final.doc <br />