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i <br /> ' ' . � <br /> Backwater Prevention Device <br /> EY Property Owner Rebate Form <br /> Please verify the following items: I <br /> • � i i am the owner of the property served by the side se�ver �vhere the Back�vater <br /> Pr:vention Device was installed. � <br /> i <br /> � � :I worked v✓ith my conlraclor to determine the installation location for lhe Backwater <br /> 'Prevention Device. I understand that the final decisio�i regarding installation location <br /> was mine: <br /> �,If the Back�valer Prevention Device was instal�ed pn 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 exr.lusively responsibte to maintain it and to keep it in good working <br /> order. <br /> • If I sell my property, I will make the buyel aware of the Backwater <br /> Prevention Device and the need to maintain it. <br /> ' Clioose one of the following: <br /> � As of�ow, my property has no downspouts or other onsite drainage that connects to <br /> Ih side sewer upstream of the,installed Backwater Prevention Qevice. <br /> or I <br /> ❑ I still have downspouts or other onsite drainage that connects lo the side sewer <br /> upstream of the installed Backwater Prevention Device. I undersland that leaving these <br /> connections means that the risk of flooding from downspout or onsite drainage ramains. <br /> I accept tliat risk. i <br /> f i <br /> Signature ,D te: �/I � I� <br /> �. .._�_, <br /> 4I�, <br /> I <br /> I <br /> I <br /> I ' <br /> � <br /> iPage 2 nl 2 <br /> i <br /> . � <br /> Revised 0 9109/2 0 7 4 � <br /> I <br />