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. e d^ '� �ra' � ��.`� � 'I�f q- � . <br />�S> �. ' ;a�i � � � ' t"v, , � k. 3 :. <br />� . - _� . .. .,.. <br />�„ � — . � y.� �", . . <br />F, r' � � ..y. } <br />I 31G� k E_; : a.���,� ��4 } �� S X 3 <br />� :. <br />Property Own2t PVarr'�e: � g � �,. � � �. �' � � <br />Instailation Address: , ��'� ��4`���c� d��. �°�`� <br />Cify_ �i1�,�`,� #�� St�fe_ ��"� Zip: � �-� <br />Mailing Address {if different): <br />Cifiy: Stafie: Zip: <br />Emaii: �� �� � � � � � ��` �.�' � �`�� A 4 �- Phone: (��� �}"�- � �`�' �- <br />Tota! Cost fa tnsf�I! Device (from conPracit�rinvoic�j: � ��I �� �� <br />� f am the ovuner o€ ti�e prop�rr"eyy where the backwater preven�ion device was insta{led. <br />�g � <br />❑ I worked vvi�h the contracts�r io deterrnine the locatic�n for the backw�fer prevention device and <br />u�ders�and t9�ai �he decision regarding the Ic�cation af the device w�s mine. <br />❑ My contr�ctor in$tructed me how to acc�ss, inspect, �nci rnairtfain the deviee. <br />❑ l undersiand fha� i am responsible for maintaining the b�ci�vater pre�.rention d�vice and keeping <br />it in good workir�g order, untess it is insta€Ied in the city right-of-v+ray. <br />❑!€ l se(I my property, I wi(! make potentia{ buyers aware of fhe backwaier prevenfian device and <br />the need to inspeer and rnaintain it on a regular basis. <br />❑ i a�ri enciosing all of fhe necessary paperworkc (use the yeiiouv Rebate Submitta( CheckSist). ; <br />�e8��� 4r�� ��� ��Ilsa�rv�ng: <br />� Ttie contractor iden�i�ied d�wnspouts �r other drainage I[ines that were conr�ected io my �ev��r <br />Eine (�etween my house ar�d ihe installed d�vice} �rrd removed, or rerau#ed them. <br />❑ To my knowtedg�, my proper�y �as na downspo�€ts or o�her drainagz cannected ic� my �ewer iine <br />(i�e�rnr�en my hQu�e �nd fhe insfiaiCed device}.. <br />❑ There are downspouis or oiher �l�ainage lines cn�necfed �o my sewer line (bs�nreen my hz�use <br />and the insial(ed device). i undersiand that leaving ihese connec#ians cre�fes a risk af fl�c�din9 <br />a�d I accep� that ris'�c_ <br />� � <br />�� � � ���� � �°' � <br />�������� s <br />_...�.-�° � � � k <br />