Laserfiche WebLink
(4L packvSgalair pirnwendan vev�ca Rebate pIrOgaadd. <br />Rem Applicadan Fonn <br />Property Owner Name:— <br />Installation Address: !%C,2„ <br />City. f4A:f�l'r state: UIP�rip: 9 8O2- o <br />Mailing Address (ifdrflererd): <br />City: fliy�-- State: Zip:. fe2 I l �( <br />Phone:(,0) Z) <br />Total Cost to install Device (from contracforinvoice): $ <br />Plee_,a verwy the follming: <br />t am the owner of the property inhere the backwater prevention device was installed. <br />[ I worked with the oorrtrar3ur to deterrnine the location for the backwater prevention device and <br />underswnd that the decision regarding the location of the device was mine. <br />W"MA - contractor InstnucM me how to access, Inspect, and maintain the device. <br />I understand that t am r-•sponsible for maintainirG the backwater prevention device and keeping <br />it in good working order, unless it is Installed in the city right-of4ay. <br />If I sell my pmpady, I vfill make potential buyers aware of the backwater prevention device and <br />the.need to inspect and maintain it on a regular basis. <br />12!l am enclosing all of the necessary papanvork (use the yellow Rebate Submitted Chect;Ilst). <br />Seisct from the foltotvrng: <br />'The oaritractor identified downspouts or odtter drainage Illnes thst were connected to my sewNer <br />I:ne (behwaen my house and the installed device) and removed, or rerouted them. <br />❑ To my knowledge, my property has no downspouts or other drainage connected to my server lino <br />(between my house and the installed device). <br />t( There are downspouts or other drainage lines connected to my sewer line (botween my house <br />and the installed device). I understand that leaving these connections creates a risk of flooding <br />and i atmvt that risk. <br />S1f1rrMVre Dare �L lJ <br />