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' <br /> ^ <br /> Backwater Prevention Device Rebate Program <br /> ������ ���l'���'on Form <br /> Rebate Application-�� <br /> Property Owner Name: WID(itdilde METCALF <br /> Installation Address: <br /> Mailing Address (if difterent): <br /> City: State: Zip: <br /> Total Cost to Install Device(from contractor invoice):$ <br /> Please verity the following: <br /> EWTI-Iarn the owner of the property where the backwater prevention device was installed. <br /> 2 ' --'-- ' for backwater prevention device and ' <br /> understand <br /> that the decision regarding the location ofthe device was mina. <br /> -~~/' contractor instructed nv* how tnaccess, inspect, and maintain the device. | <br /> r�'�'underntmndthat Iamresponsible for maintaining the backwater pnevenUondevice and keeping <br /> ' <br /> �� �it in0oodwo/kingnnder' un\easitiuinatm|od |nthanityhQht'of+may. <br /> :�2 <br /> I sell my property, I will make potential buyers aware of the backwater prevention device and <br /> the need hoinspect and maintain itunaregular basis. <br /> , nomndooin0aUofthenaommmarypapen^mrK(uaethoyoUmmRaUate Submittal Checklist). <br /> /�� / u <br /> Select from the following: <br /> -- onntnadoridant�nddVvvnopou� other my sewer <br /> �� <br /> --The <br /> line (between myhouoe and the installed device) and removed, orrerouted them. <br /> �l <br /> To my knowledge, my property has no downspouts or other drainage connected to my sewer line <br /> ^~ <br /> (between myhouse and the installed dsaica). <br /> There are downspouts orother drainage lines connected tnnnysewer line (between nhouse <br /> nune <br /> andthninytmUaddevice)' | unUarstondthai\eejnQtheaeoonneoUormuremtomorimkofflooding <br /> and laccept that risk. <br /> 11 Date / <br /> ' <br /> -'~ - ��� ` ' xy <br /> ` <br /> � <br />