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� <br />� <br />r <br />k ,y. �, � r,�,.. u s s `a�. t�,.e < . �`ue .vt.. � .v�E� <br />Backwater Prevention Device <br />Property Owner Rebate Form <br />Please erity the following items: <br />I am the owner of lhe property served by the side sewer where the Back�vater <br />Prevenlion Device was installed. <br />�orked wilh my contractor to determine the installation localion for lhe Back�vater <br />Prevention Device. I understand that lhe final decision regarding installation location <br />was mine. <br />f the Backwater Prevention Device v✓as installed on my property: <br />• I have been sho�vn how lo access, inspect, and maintain my device hy my <br />contractor <br />• I understand the City will not mainlain the Back�vater Prevention Device. I <br />am exclusively responsible to maintain it and to keep it in good working <br />order. <br />If I sell my property, I will make the buyer aware of the Backwater <br />Prevention Device and the need to maintain it. <br />Choose one of the following: <br />0 s of now, my property has no doevnspouts or other onsite drainage that connecls to <br />the side sewer upstream of the installed Backwafer Prevention Device. <br />or <br />� I still have downspouts or other onsile drainage that connects to the side sewer <br />upslream of the installed Backwater Prevention Device I understand that leaving these <br />conneclions means that tlie risk of flooding irom downspoul or onsite drainage remains. <br />I accept that risk. <br />-ti� <br />Signature�� ���•'l�/� � �� � �'V� Date � G <br />. , <br />r/ <br />Page 2 of 2 <br />ReviSed 09/09I2014 <br />