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Backwater Prevention Device Rebate Program <br /> Rebate Application m <br /> rm <br /> Property Owner Name. <br /> Installation Address: TT_ <br /> City: —State: Zip: <br /> Mailing Address(if different): <br /> City: State: Zip: <br /> Email: Phone: <br /> Total Cost to Install Device (from contractor invoice): $ <br /> Please verify the following: <br /> am the owner of the property where the backwater prevention device was installed. <br /> with the oonbautortodcternninethe location for the bankm/mtmrpreven�ondevice and <br /> ��^ understand that the decision regarding the location ofthe device was mine. <br /> oontnmctorinstructed mehow toaccess, inspect, and maintain the device. <br /> ' dendmndthat| mmnresponsible for maintaining the backwater prevenUondevice and keeping <br /> �~ itingoodxvurkinQmodmr. un|emmitisinstaUedintheuitnriQht-of+mey. <br /> IL-1 Al sell my property, I will make potential buyers aware ofthe backwater prevention device and <br /> (Fthe need toinspect and maintain itonaregular basis. <br /> |amenclosing all ofthe necessary paperwork(use the yellow Rebate Submittal Cheok|imU. <br /> -sVaotfcommtbefoNmming: <br /> The contractor identified downspouts or other drainage Ilines that were connected to my sewer <br /> line(between my house and the installed device) and removed, or rerouted them. <br /> E] 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 /> 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. <br /> � <br />