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�jw Bacl�water Prevention Device � '��
<br /> � Pro �ert Owner
<br /> _ _, E y Rebate Form �
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<br /> Plcase verify the following i•:erns: !
<br /> ��� :3T ffl;? Ol;ll�f U� lflrJ �1fOpCfty �E'fVi.'.0 hy ���C 51C:t; SCIl'C'.� 1'i�1Cf'�9 ��lf' Hai'.kty2�i." ��
<br /> Pra�_�nh^n ;"1.:,;�co :voe. inctollc:d
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<br /> Prr�,:onhor DPv�ce I �.n d�^�;•any tht�i ft:�� 1in,� �1..ri c,r� ��tc:�r.linr, in�'c;ii.:i'"� , �r.-�:�t �����
<br /> �;<;, n� i�o.
<br /> �(!�� '� �' f3,�ck�;alei Prev?n6on D�,�ice was installeC un rny property �
<br /> • i have been sh�r,:n ho�v te access, h�spect, and maintam rny dev:� ;�y m} '
<br /> cuntra;;;or ,
<br /> • ! inr:crstand the City wdi not ��aiN.��r tl�e Back�a�ater prr:venb,,�i ;;��•.1��.� I '
<br /> m• nxrluvv al� r�<_po�isiblc �i� r^aritan il ;md ?c koe�� �t in �o..,.:i :�. ;r4 ry �
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<br /> • �` � srll rny {�ropeity. I �.t�iH make RtF t'�uqer �:��,ai�_ n( t���e E��r;�t:',�Iv,
<br /> r'%eva���:�ni �rvir:� ;;nr (hc nae�f tn �ra nt���n it
<br /> Choose cne of the following:
<br /> ,.6�1�ti �:` no1:'. m�• �-.r��pC•rtp h9�; r� �yn�y•.•��n�uls ri� n!I�e�i :i��t,di� J��nnaUtt Il��rt run'1, �.P, t��r
<br /> •h„ �;idc suv:er upstrr,am ot li�,i; insl:�ilt�r. Eiack�•,��1�_� f�i�:�a�iti�m f)c�� �-"-
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<br /> ,, I slili h;3ve do�•:nspuuts nr o�ner nr,sile �h.iin;i���, tn;at ccnn�cls tr; �h� s d:� s��r.��i
<br /> �,ipsireant ��' �h�� in;�a '�,.! 13ar4.v,.�L�i Pnr:i�r�:io^ U�v�.�� I iin�.ir�;,���t��,; Ihr�l Irtr,�inr, � i_��.
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