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Bachrvatqr Prevention Device Rebate Program <br /> Rebate Application For <br /> Property Owner Name: <br /> Installation Address: <br /> City: ���..9 t State: X _1"),L _Zip:V b l <br /> i <br /> Mailing Address(if different): <br /> City_ State: zip: <br /> Email: Phone: ( ) <br /> Total Cost to Instal! Device (tram contractor invoice): $ <br /> fir <br /> Meas verb the f�allowlng: <br /> l am the owner of the property where the bacloNater prevention device was installed. <br /> ffl-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 /> ❑� 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 1 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 an a regular basis. <br /> ❑ 1 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 Ilines that were connected to my sewer <br /> 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). <br /> ❑ There are downspouts or other drainage lines connected to my sewer fine(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 /> 1 <br />