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<br /> <br /> William P. Kenoi BJ Leithead Todd <br /> <br />MayorDirector <br /> <br />Margaret K. Masunaga <br /> <br />Deputy <br /> <br /> <br /> <br />East Hawai‘i Office <br />West Hawai‘i Office <br />County of Hawai‘i 101 Pauahi Street, Suite 3 <br />74-5044 Ane Keohokalole Hwy <br />Hilo, Hawai‘i 96720 <br />Kailua-Kona, Hawai‘i 96740 <br />Phone (808) 961-8288 <br />Phone (808) 323-4770 <br />PLANNING DEPARTMENT <br />Fax (808) 961-8742 <br />Fax (808) 327-3563 <br /> <br /> <br /> <br />SPECIAL MANAGEMENT AREA USE PERMIT ASSESSMENT APPLICATION <br /> <br />APPLICANT INFORMATION (Applicant is the person or entity actually responsible for the proposed use, activity or <br />operation—typically the landowner or lessee.) <br /> <br />APPLICANT’S NAME(S): <br /> <br /> <br />ADDRESS: <br /> <br /> <br />CITY:STATE:ZIP CODE: <br /> <br /> <br />EMAIL: <br /> <br /> <br />PHONE NUMBER(S):bus:hm /cell: <br /> <br />SIGNATURE(S):DATE: <br /> <br /> <br />LANDOWNER INFORMATION SAME AS APPLICANT (may leave this section blank) <br /> <br /> <br />LANDOWNER’S NAME(S): <br /> <br /> <br />ADDRESS: <br /> <br /> <br />CITY:STATE:ZIP CODE: <br /> <br /> <br />EMAIL: <br /> <br /> <br />PHONE NUMBER(S):bus:hm /cell: <br /> <br />SIGNATURE(S):DATE: <br /> <br /> <br /> Landowner agrees to grant representatives of the County of Hawai‘i the right to enter the property at <br />reasonable business hours for the purpose of site inspection. <br /> <br />AUTHORIZED AGENT/ CONTACT PERSON <br /> <br /> <br />CONTACT NAME(S): <br /> <br /> <br />ADDRESS: <br /> <br /> <br />CITY:STATE:ZIP CODE: <br /> <br /> <br />EMAIL: <br /> <br /> <br />PHONE NUMBER(S):bus:hm /cell: <br /> <br />SIGNATURE(S):DATE: <br /> <br /> <br /> <br />TAX MAP KEY(S): <br /> <br /> <br /> <br />Hawai`i County is an Equal Opportunity Provider and Employer <br />www.cohplanningdept.com planning@co.hawaii.hi.us <br /> <br />