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Backwater Prevention Device.-R-9 rogram <br /> Rebate Applicata n.Tor <br /> Property Owner Narne <br /> InstWlfation Address: <br /> GrCy _ _ _ state: it yip V <br /> Mailing address(if different): -- <br /> City:�k _ Mate:- Zip: <br /> Email: 't Phone:(LWT��� .: <br /> Total east to lnstoll Device(from contract©rinvoice): <br /> Please verify the following: <br /> ! Im the owner of the property where the backwater prevention device was installed. <br /> E] .1 worked with the contractor to determine the location for the back%lkter prevention device and <br /> understand that the decision regarding the location of the device was mine. <br /> Nty contractor instructed rne,how to access,inspect,and rn@intain 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.; <br /> If I sell my property,I will make potential buyers aware of the backw6ter prevention device and <br /> r the need to inspect and maintain it an a regular basis. <br /> f am enclosing all of the necessary paperwork(use the yellow Raton c;submittal Gbe;cklist), <br /> elect from the following: <br /> i"he contractor identified downspouts or other drainage Innes that were connected to my sewer <br /> litre(between nay house and the installed device)and removed,or rerouted them. <br /> L] To nay knowledge,my property has no downspouts or other drainage connected to my sewer line <br /> (between MY house and the installed device). <br /> ❑ There ane downspouts or other drainage lines connected to my sewer line(bet+,veen my house <br /> and the installeddevice).I understand that leaving these connections creates a risk sof flooding <br /> and f accept that risk. <br /> Sir�att r n 2 <br /> Date <br /> l <br /> ' r <br /> l'. <br /> t <br /> t <br /> t <br /> t <br /> r <br /> i <br />