Laserfiche WebLink
s <br /> s <br /> °s <br /> s <br /> t <br /> I <br /> i <br /> 3 <br /> Backwater Prevention Device Rebate Program <br /> 04L Rebate Application Form <br /> Property Owner Name: <br /> Installation Address: <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): $ 1 <br /> r <br /> Please verify the following: <br /> I am 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 /> � <br /> U is <br /> (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. <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 /> P(I am enclosing all of the necessary paperwork(use the yellow Rebate Submittal Checklist). <br /> Select from the following: ' <br /> 1 <br /> ❑ The contractor identified downspouts or other drainage alines that were connected to my sewer <br /> line (between my house and the installed device)and removed, or rerouted them. <br /> Ef" is <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). <br /> ❑ 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 t <br /> and I accept that risk. E <br /> i <br /> f <br /> i <br /> k <br /> r <br /> j <br /> Signat v w Date 2 <br /> 1 <br /> i <br /> I <br /> 3 <br /> }I33 <br /> I <br />