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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: NW corner of Keanalehu Dr.and Manawalea St. Date: January 1,2013 TMK No.: (3)7-4-21: 10 and portion of 12 Applicant Information: Contractor Information: Name: Jobie M.K.Masagatani Name: Address: 91-5420 Kapolei Pkwy,Kapolei,HI 96707 Address: Company: State of Hawaii,Dept.of Hawaiian Home Lands Company: Phone No.: 808 620-9501 Phone No.: Check applicable box:' Sewer Main Installation (Indicate reason for work and complete Parts B&C.) XSewer Lateral Installation (Indicate reason for work and complete Part C) Reason For Work: To construct the necessary infrastructure(sewer mains and laterals)to provide sewer service to the proposed 117 house lots,boat parking lot and park lot. Part B. Sewer extensions are subject to Hawai'i County Code,Chapter 21,Division 4 Extensions and the APPLICANT shall be responsible for submitting 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. Section 21-28(b)(1): County constructs, applicant pays. ❑ Section 21-28(b)(2): County constructs, applicant and County share cost. ❑ Estimated Start Date March 2014 Estimated Completion Date April 2015 Part C. I hereby certify that all work requ li -• above will conform to appropriate sections of the Hawaii County Code. Owner Signature: / i % t.'�IL Date: UA(� 1 4 2013 Department of Environmental Management, Wastewater Division Approved by: Date: k/430 Wastewater Division Chief Approved by: Met � Date: 41/A J/ /3 Di r of Environmental Management Note: 1) Approval of the Application for Sewer Extension does NOT constitute approval for construction. Approval for construction is provided by an approved Permit to Perform Work on the Public Sewer System pending final approval by the Hawaii County Council in accordance with Section 21-26.1 of the Hawaii County Code. 2) Filing of Sewer Extension Resolution is not required for sewer lateral installations. Hawai'i County is an Equal Opportunity Provider and Employer 0:\Wastewater\FORMS\070202 Sewer Extension Application-Final.doc