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<br /> Backwater Prevention Device
<br /> �� Pro ert Owner Rebate Form :.
<br /> -- P Y
<br /> Pl�ase verify the following items: i
<br /> ��fn' the ;ur� i cif th� Ni��perty sur•dr:d by lhr sulr, se�•:ei tviierH Ihe E�acktv;a;rn �
<br /> i'revenlion I)�vic�: ��-a5 i�e;:alled �
<br /> �'�I v�orked �:�lh np� ,�onh<�clor tu deturmine thr, insta,!oti�m Inr.�ition for the B�ckrratar ,
<br /> I��c�vun:ion Dev�co I �,n�ierstand ih,�t �`u� fin�+l der.ision r��,arcm� mstall��Uou Ir,c:afion �
<br /> ,::+s mine
<br /> v j� ��,�. L'.n� E.r.,dr�i Prev��n;�rm I lev��,: �vds nslalled ���i my propeity �
<br /> . I I�,ive br:en shnwn I�r��v to a�,rr�ss. mspec:, ;�no maintair, my �I�vic^ by my
<br /> ;���tractor
<br /> • ���ferstar;d !he C�ly wi;l ��ol ni;aintain ihe: Back�,vater Prevantion Dev;ce. I
<br /> u�� ��xr,lusiv��ly respcns i>k; to mr��•itain i' ann !o hr,ep i! in good v;orkiny �
<br /> � r���r �
<br /> • I! � �:cil ���y {.:,�t,�:ity I rrll r�ake 'he b�ay���i a�vara nf Ih�. Ci�ck�vot�:r �
<br /> r�.y�:r'icr� �-•��ir� anrl f�i� ner•d tn rnainla�n il �
<br /> Choosc one of thc following:
<br /> t�; uf no�v. r��y property lu:s n�> duv:nsE;c�u�� or r�t�x�i ur,;�t� cnina,yc tna: �.�::mier,i:. lo �,
<br /> U �.� ,i.:r: se�;er upstream of ?h�- irst��llc�d E3�ck���;�;er Prev��ntir,� I)evic��
<br /> I � I e.!ul hr�ve dov,nsoouts rn �ill�r,r or.; le r.raina��c thnt rnnner.L: fr� Ri�� tiiriu sewnr �
<br /> u�,�;tr,�;un u( th�� n�,st.illeit R;i;�hw�itr•r I'revenuon Ucvice I un�L•rst,iril Ihat Ieavmq Y�ase �
<br /> i ��I111�'�.�I�:fP�, ;I �"'-l!�,. ',�i;i� l�lr II:h l�f �.Ir,r�ill�; �I�'f7 :1:;1Vf1C(t�ll� �i' �tli�,l'�: I�f.lii'Ji�i: 11•!1',III"�
<br /> � �i� l 1�1'� t�l.l� I'l. . . .
<br /> Siqnr�furc . �' .;.2�+r1,_ �.'�-�,-� . � D,7te I 4�z ) I '�-�
<br /> �r , . _. -C� - � _
<br /> �',�.;� :� �:
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