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t <br /> Backwater Prevention Device Rebate Program <br /> Rebate Application Form <br /> Property Owner Nam <br /> Installation Address: zILP& -f � <br /> City: State: Zip: <br /> Mailing Address(if different): <br /> City: State: zip: <br /> Email: Phone:( ) <br /> Total Cost to Install Device(from contractor invoice):$ <br /> l <br /> Please verify the following: <br /> VI <br /> m the owner of the property where the backwater prevention device was installed. <br /> worked with the contractor to determine the location for the backwater prevention device and <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 /> understand that 1 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. <br /> If I sell my property, I will make potential buyers aware of the backwater prevention device and <br /> the need to inspect and maintain it on a regular basis, <br /> ,A/I am enclosing all of the necessary paperwork(use the yellow Rebate Submittal Checklist). <br /> 7Selec ,from the following: <br /> The contractor Identified downspouts or other drainage[lines that were connected to my sewer <br /> line(between my house and the installed device) and removed, or rerouted them. <br /> 2" T o my knowledge, my property has no downspouts or other drainage connected to my sewer line <br /> (between my house and the installed device). <br /> There are downspouts or other drainage tines 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. <br /> Signatur Date <br /> i <br /> .. l <br />