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Bac ater rev�enti�n D+�v�ce R���t� Pr��ram <br /> �ebate Ap�lic�ti�n For : ; <br /> Property Owner Name: ��`�`'��``? " '' a� �?.�1�,�:�. t�."A��..�. <br /> , , � , <br /> Installation Address: -°�a�;��. � ���'_���� ��`'��;��.�4�`��� ������-°" ��(°' � <br /> City��" kl�'�.�� State: �.���°�`'- Zip: ����� �-�'�� ' <br /> � <br /> Mailing Address(ifdifferent}: - ; � <br /> ;Gity: , State: Zip: , � <br /> EmaiL• Phone: ( ) � <br /> .:. . , <br /> �; . , <br /> 7ota1 Cost to InstaA Llevice(from contractor invoice): $ <br /> � � ` � <br /> � <br /> ,, . - , _ _,_ : . '. . .. . . . � <br /> Please ver�fy the following: <br /> � < : <br /> -I arr�the owner of the properiy where the backwater prevention device wr�s installed. ' <br /> �!wrorked with the contractor#a detes-rnine fhe location for the backwater prevention device and <br /> �< understand fhat the decision regarding the location of the device was rriine. ` � <br /> �� <br /> . _.:__.. <br /> < <br /> ` ` �°�`My contractor instruc#ed me houv'to access, inspect,and maintain the device. � � -`�~ � <br /> I understand that 1 am responsible for maintaining the backwater prevention device and keeping � <br /> it in good vtirorking order, unless it is installed in the city right-Qf-way.' <br /> ; :, � , ° <br /> ` �°�``�If I se[I my.property, I wiA make potential buyers aware of the backwater prebention device and <br /> �,��,the need to inspect and maintain'it on a regular basis. <br /> �_ � <br /> __�am encfosing aU of the necessary paperwork,(use the yellow Rebate Submittal Ghecklist). <br /> S�le�t from the foilowding: : <br /> , : <br /> ` Q; 7he cantractar�dentified downspauts or other drainage llines that were�onnected to my sewer ; <br /> line�between my ho�ase ar�d t�e inst�lted d�vice}an�i remaved, or rert�ufed them.' <br /> �°'To my knQwledge, my praperty has ng do�n+nspouts or other drainage cannected to my sevrer tine � <br /> �he�iween my house and the installed devics). , <br /> ❑ There are downspou#s or oiher drain��e lines connected to rny sewer line(between my house" <br /> and#he installed device)_ I understanci th�t leaving these connectians creates a risk of flooding <br /> and t accept khat risk. <br /> ��",. �-....:�� <br /> � �.� ��—�=� A _�� s <br /> ;'�l91R8tW� .ri,.�. __ Qa#e �,.��._�' _ t � �' � <br /> �:.� <br /> . <br /> >_ __ . , , :. ; <br /> _ _ ; <br />