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Backwater Prevention Device Rebate Program
<br /> Rebate Application Form
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<br /> Property Owner Name:
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<br /> Installation Address: <-
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<br /> City: State: r .
<br /> Zip:
<br /> Mailing Address (if different):
<br /> City: State: Zip:
<br /> Email: Phone: ( )
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<br /> Total Cost to Install Device (from contractor invoice): $ op t4 3/,.....
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<br /> Please verify the following:
<br /> ' k'fil am the owner of the property where the backwater prevention device was installed.
<br /> [ 1 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 /> FMy 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
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<br /> ( it in good working order, unless t is installed in the city right-of-way.
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<br /> .., i rp If I sell my property, I will make potential buyers aware of the backwater prevention device and
<br /> ''' 'i'ii<i;i.l.diii i' the need to inspect and maintain it on a regular
<br /> arbasis.
<br /> (0. I am enclosing all of the necessary paperwork(use the yellow Rebate Submittal Checklist).
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<br /> Select from the following:
<br /> i,;1/411 The contractor identified downspouts or other drainage !lines 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 /> .... . ,
<br /> .... ,,
<br /> There are downspouts or other drainage lines connected to my sewer line (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.
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