VI. FOR TRENCHING INFORMATION ONLY Tax Map Key(s):
Work to be performed for: Work to be done:
Service Connection Repair Borings
Estimated Dates: Start: Completion: Other:
Estimated Value of work: $ Dimensions: ft/in ft/in ft/in
in the city right - of - way
length width depth
DPP, Wastewater Branch 768-8210
DTS, Traffic Signal 768-8388
DDC, Street Lightning 768-8431
BWS, Customer Care 748-5460
Hawaiian Electric Co., Inc., Engineering Division
543-5654
Hawaiian Telcom, Excavation 546-7746
Gasco., Inc., Maps & Records 594-5575
Spectrum, Engineering & Construction 625-8443
786-3600
VII. FOR SEWER CONNECTION INFORMATION ONLY To receive a response via e-mail,provide email address below and check box here:
Residential: No. of Proposed Units (Provide breakdown below)
Studios 1 Bedroom 2 Bedrooms 3 Bedrooms 4 Bedrooms Other
Non-Residential: (See attached sewer table for required category and quantity and provide any additional information in the remarks)
Date of Connection: Connection Work Desired:
Use Existing Lateral Other
(approximate)
Dimensions: ft. in. ft.
len
th size de
th
Existing Structures/Dwellings on Property: (Provide breakdown below)
QUANTITY(IES)
Remarks: (Provide any additional information on the lines provided) To receive a response via e-mail,provide email address below and check box here:
Date of Application: Received By: Application No.:
rev. 10/2020
DFM, Division of Road Maintenance
(if trenching 200 linear feet or more)
ADDRESS
650 So. King St., FMB, 1st Flr.
650 So. King St., FMB, 2nd Flr.
650 So. King St., FMB, 11th Flr.
DATE
630 So. Beretania St., 1st Flr.
NEW WATER METER SIZE(S)
PHONE NO.
Note to the applicants receiving clearances: The utilities listed above may not represent all underground utilities located within City rights-of-ways, nor do
their utility clearances relieve the permittee from complying with all other applicable codes, rules, regulations, and/or permit procedures including, but not
limited to, additional clearances and requirements for other utilities (i.e. irrigation, data transmission, etc.) located within City rights-of-ways. Pursuant to
ROH 1990, Section 14-17.6, the permittee shall indemnify and save harmless the city for any injuries or damages to any person or property received or
sustained by any person as a consequence of any act or acts of the permitee on work done under the trenching permit.
Note to agencies providing clearances: Signatures on this form may be reproduced (scanned and emailed) and submitted electronically for permitting purposes in
accordance with HRS Chapter 489E. Original wet signatures may be retained by the applicant(s).
DPP: Dept. of Planning and Permitting DTS: Dept. of Transportation Services DDC: Dept. of Design and Construction BWS: Board of Water Supply DFM: Dept. of Facility Maintenance
820 Ward Avenue, 4th Flr.
1177 Bishop St., Lobby
515 Kamakee St., 1st Flr.
200 Akamainui St.
haw.engineering.research@charter.com
99-999 Iwaena Street, #214
SITE DEVELOPMENT DIVISION MASTER APPLICATION FOR
(REVERSE SIDE)
SIGNATUREAGENCY CLEARANCES
FOR DIVISION USE ONLY:
REMAIN DEMOLISHTYPE (i.e. Single Family)
CATEGORY(IES) QUANTITY(IES)
