Laserfiche WebLink
i <br /> I <br /> i <br /> i <br /> i <br /> Backwater Prevention Device Rebate Program <br /> ,r Rebate Application Form <br /> Property Owner Name: i <br /> Installation Address: <br /> 3 <br /> City: _State:_�Zip_ <br /> F <br /> S <br /> Mailing Address(if different): <br /> G <br /> City: State: Zip: <br /> Email: Phone: ( ) <br /> Total Cost to Install Device(from contractor invoice): $ <br /> Please verify the following: <br /> I am the owner of the property where the backwater prevention device was installed. <br /> I worked with the contractor to determine the Location for the backwater prevention device and a <br /> understand that the decision regarding the location of the device was mine. <br /> My contractor instructed me how to access, inspect, and maintain the device. }. <br /> I understand that i am responsible for maintaining the backwater prevention device and keeping <br /> it in good working order, unless it is installed in the city right-of-way. t <br /> (yif I sell my property, I will make potential buyers aware of the backwater prevention device and y <br /> the need to inspect and maintain it on a regular basis. i <br /> I am enclosing all of the necessary paperwork(use the yellow Rebate Submittal Checklist). <br /> Select from the following: <br /> The contractor identified downspouts or other drainage(lines that were connected to my sewer <br /> 7 line (between 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 sewer line <br /> (between my house and the installed device). 3 <br /> [j There are downspouts or other drainage lines connected to my sewer line (between my house <br /> and the installed device). I understand that leaving these connections creates a risk of flooding <br /> and I accept that risk. E <br /> Segeaatuse <br /> Date <br /> s <br /> i <br /> i <br />