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' Backwater Prevention Device <br /> .. F� � Property Owner Rebate Form <br /> Pleas� vcrify thc tollowing items: <br /> �ri am tlut �i:vni�� of �he ��r��Ucily si,r�nd by Um. :;iCe sNwin �•�here the B:ir.hwatc+i � <br /> f'iev!-ntio•i I)��v:ce �•,�:�s ins�alied <br /> ;,�1 �vnrEed �n,th ny r.�.�nir�ctoi tu det��rrni�in lhe in:;taqtition ,oc,Y.ion (er the Backwalei <br /> Pr�v�n'i^n Ur�v����z I �indec;lai�d that tl���� ` nal decision i���garcmg �nsta!latior i��cation <br /> �:�as min�� , <br /> ,;-1( ih� iinckw„I�er F'ir-vention Di�va:i� N�as installed �m. nry �.ii� �rty � <br /> • I have bc�.n shoa�i how to access, �n;pect, anr, n.,dntam nry device by rny <br /> � oniraclor � <br /> • { cnder:tand Ihe City ��;ill not maint�i•i (he E3ar,htivater Prevent�on Uuvice I � <br /> ,-m exclusn�rly responsi'nlo tu mainta�n i! �nd tn keep it in gond �vnrkmg <br /> �,rder <br /> . If I snll my Fxr�peily, I v;�ll make the buyer a�vai�.: uf �hc P,ar,k�•.;;te. <br /> F'rr.vent nn f)evir,e ;in� ll•c� n^��d tn m �int�.n d <br /> Choose one cf the following: <br /> ��s ot nu�v. rnv prr��ierty h�s r�� rinwnst'�out+s „r .��her nnsil� drainar,�� Ihai cnnnects to � <br /> th�r side �er;c�� u���lie,un ��1 thFt in;talled f3xk��;at�:r Prevention Devic�� <br /> oi , <br /> [ � I ;ti�l I•�ive �fu�vns(r,r.�ls rn r�th��! rms'�n drain,�ge thrtt cunneclti to �he side sc�vci � <br /> u�.r,tir�nr^� nl In•�� m�;Li!Ir_d f3,�i.k�v�ilcr I'ir.veiitinn ��vir.�� I und��isf,�nd lh��t I��trv n� iht�se• <br /> �,�.,i, i��dini�s rneans th,�t lhe n::k �,f fluudmg fr�rn �lownstxwl or unsite drama��r� irniains_ <br /> I �ur,,�i� thnt nsh <br /> I. � <br /> Siy��aturn �l'tth�l,�,�. _ -- Date 1�� I � `' <br /> � �_ <br /> i <br /> —.o{,� .' �.1. <br /> ftrvi:o I I1.� r;�'.' �11 <br />