Laserfiche WebLink
DW <br /> RM W, <br /> a0 <br /> W <br /> M t <br /> r\a > <br /> Prnpe i Name`y <br /> \nom_ \ Irtstalla ;fldress <br /> ` 'n Y/c ' Y <br /> Mdlling Address�ifdlfherant) � "=y§ <br /> o�. <br /> y � � � •Zip <br /> s. <br /> Erna x, zR <br /> Total Cosft fnstall t?evN <br /> oe <br /> tiJ r t $h f lolRtln a <br /> t am the yawner attte prgperty�e� r,-Prevention devi <br /> I ituo e a th ntraptor try termi-11-1 the he backwa#�r ipr'u d <br /> underdat tf th t1h dell t h regarding the-1 n evice:,was,min <br /> f /. <br /> My L t ii VU I s #iG B = hC7w ft33 acc#sS� tine(�' <br /> /* `y .. <br /> t ubderstand that I am responsible for mpintat ng" --b"','"pater prevention device and keeping :k <br /> Gln good workiing order;;unless tam alt e way, <br /> Y�s"3 ,/a s� <br /> l if I sell my,property;I will make potentiahbuyers wa�pithe fsaekwater prevention device and <br /> therte d#o inspect and ruin alrf it ren 6rego <br /> 1 am enclosing_ali of the"necessary pap r v c e the yellow Rebate Submittal Checklist}. <br /> Select from the following:` 2 <br /> * lie contractor identified downspouts ar other drainage nines that were connected to my scevver <br /> /, <br /> Bile{between m house the installed devices acid ret'oved,or rrt rout�ci them. <br /> ❑ T my knowledg ray property has rto,cltawnstrra or otter tiralnarae cor3riecco�l to my se'�er Jitic. <br /> satvieen,m'y httase and the Installed d i <br /> Q There are downs s rarh the r stratnage Ines. annected to rr y sewer line{k�etween r��y house <br /> and the°rs stailed/evic ,r rkohdarstand"that lee+rrttg ttre� nrinddtions creates a risk of flaodi I <br /> and I accd„ t that I Isk. � <br /> yy <br /> . 4,. , / s <br /> rZr <br /> Si nOure <br /> a <br />