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. . i <br /> BacFcwater l�revention Device <br /> Property �wner Rebate Form <br /> �-�_.____`�.�- �, <br /> , -PI� `se verify the following items:__ <br /> , ---__ � <br /> I am the nwner of the prope�Ry served by the side sewer where the Backwater <br /> �Pre ntion Device was installed. <br /> orked with my contractor to determine the installation location for the Backwater <br /> Prevention Device. I understarjd that the final decision regarding installation lo�ation <br /> �wa mine. <br /> the Bar,kwater Prevention Device was 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 will not maintain the Backwater Prevention Device. I <br /> am exclusively re,sponsible to maintain it and to keep it in good working <br /> order. . <br /> • If I sell my proper�y, I will make the buyer aware of the �3ackwater <br /> Prevention Devia: and the need lo maintain it. <br /> �''----- ---- - <br /> Choose one of the following:, -,-., <br /> �J As of now, my property hasino downspouts or other onsite drainage that connects to <br /> the side sewer upstream of the�installed Backwater Prevention Device. <br /> or <br /> ❑ I still have downspouts or o,her onsite drainage thal connecls to the side sewer <br /> upstream of the installed Backwater Prevention Device. I understand that leaving ihese - <br /> connections means that ihe risl,c of flooding from downspout or onsite drainage remains. <br /> I accept that risk. <br /> Si naturee� \��" _ � ' —�\, <br /> Lg ___.. .. �.) Date� _.. d-� � <br /> , Page 2 of 2 <br /> Revised 09/09I2014 <br />