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4E,,. Backwater Prevention Device <br /> Property Ov;me� Rebate Form <br /> Alease verify the following items:� <br /> C� I am the owner of the property served by the side sewer where the Backvdater <br /> Prevention Device was installed. <br /> E� I worked with my contractor to determine the installation location (or the Backwater <br /> Prevention Device. I understand that the final decision regarding installation location <br /> was mine. <br /> If ihe Backwater Prevention Device v�as installed on my property: <br /> • I have been shown how to access, inspect, and maintain my device by my <br /> contractor <br /> • I understand the City�vill not maintain lhe Backwater Prevention Devi�e. I <br /> am exclusively responsibie to maintain it and to keep it in good working <br /> order. <br /> • IF I sell my property, I will make the buyer ativare oF the Backwater <br /> Prevention Device and the need to maintain it. <br /> ` Ghbose one of the following: <br /> � of now, my property has no downspouts or other onsite drainage lhat connects to <br /> ' the�ide sewer upstream of the installed Backwater Prevention Device. <br /> or <br /> � still have downspouls or other onsite drainage that connects to the side sewer <br /> , '� upstream of the instalied Backwater Prevention Device. I understand that leaving these <br /> connections means that the risk of ilooding from downspout or onsite drainage remains. I <br /> accept lhat risk. <br /> C�-� ; l ;�- _ , <br /> �, Signature �J /�� Date_ �I �� _ <br /> i <br /> Page 2 ot 2 <br /> Revised 09/09/2014 <br />