Laserfiche WebLink
� Backwater Prevention Device <br /> E� ; Property Owner Rebate Form <br /> , <br /> Please verify the following itcros: <br /> �am the owner oi the property served by the s�de sevder where the Backwater <br /> Prevenlion Device �a�as installed <br /> ( ;I worked with m�y contractor to determine the installation location (or the [3ackwater <br /> Prevention Device.;l understand that ihe fmal decision regarding inslallation location <br /> �das mine. <br /> i if tlie Backwater Prevention DevicP was mstalled on my property. <br /> • I have been shown how ta ar.ce,s, inspect, and maintain my device hy my <br /> contraclor <br /> • I unders�and the City wdl not maintain the Backwaler Prevention Device. I <br /> am ezrlusively responsible to maintain it and to keep il in good woiking <br /> order. <br /> • I( I sell my properiy, I vddl make the huyer aware of th� Rackwater <br /> Prevnntion Device and the need to maintain it <br /> Choosc one of the following; <br /> ��A5 of now, my pi,operty has no downsNouts or other onsite drainage that connects to <br /> tne side sewer upsheam of the installed 68CI(\vater Prevcntion Davice <br /> or <br /> � ] I still have downspouts or other on;ite drainaye that c.onnec�s (o the side sewer <br /> u�istreani of lhe insialled Backwaler Prevention Devicr.. I undersland lhal Ieaving ihese <br /> cnnner;ions mN;3ns ihat the risk uf floodinq frnm downti��oul nr onsi�e drainayc remams <br /> I ��r.r,epf lh��t risk <br /> i <br /> � �-� <br /> Sirynature /,f/�-- - — -- --- Date, r�� `G , ?n i S <br /> � T. <br /> Page 2 of 2 <br /> RrviseJ 09�U��2U14 <br />