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i <br /> - � <br /> Backwater Preve'ntion Device � <br /> Property Owner Rebate Form ; <br /> � <br /> Please verify the following items: � <br /> ,. i � <br /> G��I am the owner of ih� property served by thc sideiSBWQf WI1P.fP. �I1C Backwater ` <br /> Prevention Devir,r was mstalled j <br /> t <br /> (� ��ti'°�k�d wdli my �onhar.tor to determine thn mslallation loca�ion for ihe Bar.kw;�ter � <br /> I'revention Device I understand Biat the(mal decision re,yarrling in,tallation localion <br /> �•;as r�ine. � <br /> , ' 1 <br /> i i <br /> (.�1(Ihe Backwater Prevent�or Dev�ce was mstalled on my property: � <br /> • I have been shov,�n ho�e- to access. Inspect, and maintain my device by my � <br /> conhactor � <br /> • I understand ihe Cdy will �iot m�lntain the Backwatef Prevention Dewr.e. I i <br /> am exclusively responsible to m��intain It and to keep il m good working t <br /> order. ; � <br /> • If I sell my property, I wilt make the buyer aware of the Back�vater � <br /> i <br /> f'revention Oevicc �nd the necd to mamtain it. ` <br /> Choose one oi thc lollowing: ' <br /> �,,} As o( no�v, rny oroperty has no downspouts or other onsite drainac�e lhat crn,nects to � <br /> "lhc side setver upstream of �ho hislalled Har.kwater Pr�vention Dewr.e { <br /> or i I <br /> � � <br /> i <br /> � � I sUll h.rve dawnspouts oi o�her onsite dramape th:i�l cnrv�ects lo thi. :;idr� sr.�vei ' <br /> up;�r�am oi lhe installed Har,kw.�tei Prr.vent.on Devir.� I understand (ha! leaving Rtese � <br /> r.cmnr.ctinns m��;ins thal lhc risk of 11ood�nr� (rom downspnut or onsita dr;iinage iomains � <br /> I c�ccept lhal ritik <br /> , <br /> , • � <br /> � � <br /> / / / <br /> Siqnattlrc� �i : j"% � �� , - / ,! � �� , � ,-- � <br /> l,�i� � ll. -�-4r�-: -r-�-'�`�i. �I�e-�" - -=='- -- � <br /> � <br /> � ; <br /> I ' <br /> � I <br /> � <br /> i <br /> I Page 2 0l2 ± <br /> � <br /> ReviscU09109�20i4 � <br />