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� Ba�ckwater Prevention Device <br /> � / FYF FfT property Owner Rebate Form <br /> , <br /> Flease verify thc following items: <br /> ��'� I �tn� t'it: c;:m•� n( �h�: �rcp_°rlv ��� .�:�_J h; fli� ;,�J� ,��:�ui c.l�eri: 'ni� I:a�nr:��'u' <br /> f'�vuiiGo:i I)��w�.�s �::nti ���itit-,p�� t ' <br /> ��'_ I vr.�rked �vith iny cun�iar�oi fu �ie�einunr ;ne instal'ati�n Ir�cahon for the Hackvl�ter <br /> f'rr�ven'r�n Dr�vira_ I undcrr:t;uid iha! t�ie (in�l dr-_r,is�r,n regard:n� insta!lahon Ir�r,��:u�n <br /> �vas n'ci:' <br /> ����� •I ,. �t u I.v.�,ilr.r �ievcntion Vev�ce c:t>>; ins�alled on rny omperty <br /> . i I�,nve oeen slio�•m hovr to ar,cess, insnert, ann rnaintain my device �y, my <br /> ��ntractor <br /> • ' un�;ur:!a���t 1'ic City �•e�ll not m�intain (he Ba�:k�vater Prevenlion Device I <br /> :in exci�.sively •�-san•�sd�le to rnain'mr d ��rd t� keep i� in gooa v�erking <br /> r;:,,i ' <br /> • 1 I sr I m•i �:roperty, I v:ul rnake thi� t�ycr ca�:�arc oF the Backvral��r � <br /> �''av��rfinn [�cvv.�� .�rd if•,e r�,�-": t�� 'nn�'ilain i <br /> Choose one of thc foUowing: ' <br /> ��,`., ��f ��o.�. �rr, � �npr,rt�r n���, nr, �:nwr�s�u�i,?s rn r.lher urr,itr� dru�nraye tha� r.or�ner.ts to <br /> 'h� sice sr:��;rr up�,ti�_,iin oi thE� inst,ill�:d Backwalcr Prr�venhon f)��vir_�t. <br /> or <br /> �. I st�ll h,ive c,rn��n;pouls ur olher onsii� ciiamnqe U�at r.unner,is �u lhr: :;ide se�t���r <br /> uostr�sun nt 'I�e n:�,lall���1 l;re�kw.rtr:i F'iuv��nlicn Ur:vice I �;n�lr�st:uul thrit irnvuty tliose <br /> ��n�in���i�oi�5 m����cs Ih.d the nsk ��( �loud.ny hu�r iL�wmpo�,d ni nn�dh� �titiu�.,ir,c n�rnainr, <br /> I � � „�q 'li,il n�.� ' � <br /> i;i <br /> / %, <br /> � �. <br /> Signnfui�, - L � , �' � , �.��� . Dafc - - — - / > <br /> r';ru, : ��f.' . <br /> I: . � ��� � �� ,�iit., <br />