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Detached Accessory Structure Within "A" Zones <br />Page 2 <br />. By initialing each box above and signing below, I am certifying the information on this Hawaii <br />County Code Chapter 27 Compliance - Detached Accessory Structure Within A" Zones form is <br />true to the best of my knowledge. I understand that any false statement may be <br />punishable by civil fine under Hawaii County Code, Chapter 27, Article 6. <br />• <br />V ' <br />PropelfOwner SI -at n re <br />Date <br />Please provide location information for the proposed detached accessory structure: <br />(3 ) a �l - 0 2/ : o 4,;L - <br />Tax Map Key <br />/ -f - 0a.ke,✓ Ave y <br />Street Address (related to Building Permit) <br />Iv q, 4 ?-� <br />City, State, Zip Code (related to Building Permit) <br />County of Hawai' i is an Equal Opportunity Provider and Employer. <br />