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..'� <br />a?� r <br />� r-` �" �., 7 �-� . .,.F <br />i. ,t� ,+.v � .`: € �u � &.. ,�' .. i t�= t! i t% i ; 3 <br />�� �L �_,. E : -:. � f'C ;. �' � q� <br />��� ��' �. �, a� � i,� -..�� € � €... Ce� . � � , : �� � ;� . � <br />Properly Owner Narr <br />lnstallation Address: <br />City_ !'�. �`'�3'� `��'" State: ( l..�l� Zip: �`� c`�i � � <br />Mailirrg Address (ifa'iifer�nt): <br />City: <br />� <br />Sta�e: Zip: <br />Email: @..f�� �.����,VY1'�,4'l (�aY�.'1 Phon�: �� t�Sr2$ � �f o"2.�i'o'�. <br />To#a! Cost fio lnstal! Device (frr�m confraefvrinuoice}: $ �.�'�� °�� � <br />� ;. ",. �. ; ,� <br />[� 1 am the owner ctf Yhe proper�y where �he backwater preventican dsvice was insfatled. <br />j�1 worked with the cantractor to deferrnine the IocaYion for the backwater preveniion device and <br />undersianc� that the decision regarding the location of the device was mine. <br />[� My contractor instructed me how to access, inspect, and rnaintain �he device. <br />�I unde�sfand thai t am responsible for maintaining the backwat�r prevention device �nd keeping <br />it in good wpr4�irzg order, unless it is installed 9n the city righfi of-w�y. . <br />[�' If I sefl my property, I uvilt make potenfial buyers aware of the �ackwater preven#ian device and <br />fhe need fo inspec# and maintain it an a regular basis. <br />{� I arn enclosing all af the necessary paperwork (use #he yelfow Rebate Submiftal Ghecklist). <br />��l�+c� f�o� the 7�IIs�e�B�g: <br />�P The cor�tract�r identified dawns�outs crr o�her drainage tlines �at were connected f4 my sewer <br />"t I��� (���,veen my hause and fh� insfalled device) and removed> or rerauted them. <br />Q To my knowledge, my prop�rty has nc► dawnspouts or ofher drainage cannecied fic� rny sewer 4ine <br />�befween my hc�use and the installed device). <br />[� There are down�pouts or other drainage .lines connecfed to my sewer tine (befw�en tny hfluse <br />anr� the ins�al(ed device). I understand that leaving ihese c�nnections creates a rislc of ftooding <br />and 1 accept 4ha�t risEc, <br />� �1�� ,� ���� _. �-� �'�.—� � <br />�►��a���r�� . <br />� <br />