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DPW Form 37(1) <br />1/12/12 County of Hawaii <br />DEPARTMENT OF PUBLIC WORKS ENGINEERING DIVISION <br />VARIANCE APPLICATION <br />(Chapter 22 — County Streets) <br />Instructions: This form is to be used for variance requests from provisions and conditions found in Chapter 22 of the Hawaii <br />County Code only. The Director of Public Works may grant a variance when all conditions of Section 22 -7.2 of the Hawaii County <br />Code are met. (See back of this form) <br />APPLICANT: <br />MAILING ADDRESS: PHONE NO.: <br />LOCATION OF VARIANCE: <br />Name of County Road <br />TAX MAP KEY: <br />VARIANCE REQUESTED FROM THE FOLLOWING SECTIONS OF CHAPTER 22 (List section numbers): <br />EXPLAIN WHY THIS IS A UNIQUE CIRCUMSTANCE AND WHY COMPLIANCE WITH SECTIONS OF CHAPTER 22 WOULD <br />BE DIFFICULT OR WOULD CAUSE UNNECESSARY HARDSHIP. (Attach additional sheets, maps, plans and other <br />supporting or explanatory documents and information as necessary. See Back - criteria 1 & 4.) <br />ARE ANY ALTERNATIVE MEASURES BEING PROPOSED? IF SO, PLEASE DESCRIBE. (Attach additional sheets, maps, <br />plans and other supporting or explanatory documents and information as necessary. See back - criteria 1 & 4.) <br />EXPLAIN WHY GRANTING OF THIS VARIANCE WOULD NOT DETRIMENTALLY AFFECT NEIGHBORING PROPERTIES <br />OR THE PUBLIC.; (SEE BACK - criteria 2 & 3) <br />By <br />Permitee's Signature <br />Director, Department of Public Works <br />Date <br />Date <br />AGENCY USE ONLY <br />VARIANCE NO: FEE: $25 <br />County of Hawaii is an Equal Opportunity Provider and Employer <br />