Laserfiche WebLink
Backwater Prevention Device Rebate Prcgram <br />Rebate Ap�lication Form <br />Property Owner Nan <br />Installation Address: <br />Cily: ( 1� .�-Q __ State: vV 1'� Zip: ��� <br />Mailing Address (ridiHerenQ: I�-1 I�� ►J •��X l��_?�� � ���X �C <br />ci�y: SV\DVl (l4-Q sta�e: )�z�P:���— <br />Email: r�t�7iSl4lVIPo�1lJ���YYIQc.iI•�IY"IYhone:��¢j ��.�'��n_!-7 <br />1A' . �� <br />Total Cost to Install Device (Irom contractorinvorce)� 5 �f� � <br />Please verlry the foflowing: <br />�m the owner ot the property where the backwater preventlon device was installed, <br />I worked wilh the contractor lo detertnine lhe location for ihe backwaler prevention device and <br />understand ihat the decision regarding the locafion of the device was mine. <br />[�]'�ily coniractor ins�nided me how to a��.ess, inspecl, atxi maintain 1he deviee. <br />I understand that I am responsible tor maintair,'•;y Ihe backwater prevention device and keeping <br />it in good worki�g orde�, unless it is installed in the city right-o(-way. <br />I( I sell my property, I will make potential buyers aware of the backwater prevention device and <br />� thP need to insper.t and maintain it on e regular basls. <br />�'�-eP� erclosing all of the necessary paperwork (use the yellow Rebate Suhmiltal Checklist). <br />lect fram the falluwing: <br />The coniractor identified downspouls or other drainage Ilines that were connecled lo my sewer <br />line (betwecn my house and Ihe insialled device) and removed, or rerouted Ihem. <br />C��J ��o my knovdedge. my property has n� downspouts or olher drai�age connecled to my sewer line <br />(belween my house and Ihe installed devicc). <br />�here are downspouls or ofher drainage lines connected �n my sewer Iine (hetween my house <br />and the installed device). I understand that leaving these conneclions creates a risk af ilooding <br />and I accept lhal risk. <br />� <br />Dafe ���� <br />