Laserfiche WebLink
; <br /> ; <br /> . . � Backwa�er Prevention Deuice <br /> � Pr�perty Owner Rebate Form <br /> Pleise verify the folbwing items: <br /> �i I jam the owner of the property served by the side sewer�vhere the Ciack�vater <br /> 'Prevention Device was installed. <br /> � <br /> � " �I iworked with my contraclor to determine the installation location for the Backveater <br /> revention Device. I understand that the final decision regarding instaliation location <br /> �vas �nine. <br /> i <br /> � �Ifjthe Back�vater Prevention Device was installed on my property: <br /> � • ' I have been shown how to access, inspect, and maintain my device by my <br /> i contractor <br /> i • . I understand the Ciry will not maintain the Backwater Prevention Device. I <br /> am exclusively responsible to maintain it and to keep it in good working <br /> i order. <br /> ; • If I sell my property, I wiil make the buyer aware of the Backwater <br /> � Prevention �evice and the need to main�ain it. <br /> i <br /> Choose one of the following: <br /> `�As of novd, my property has no downspouls or other onsite Jrainage that connects to <br /> the silde sewer upstream oF the installed Backwater Prevention Device. <br /> or � <br /> I <br /> ❑ I still have downspouts or other onsite drainage that connects to the side sewer <br /> upstream of ihe installed B�ckwater Prevention Device. I undersland that leaving these <br /> r.onneclions means lhal the risk of fiooding from downspout or onsite drainage remains. <br /> I accepl lhat risk. <br /> I <br /> ; ---� <br /> Signatrure�� ,� ���� fDate?����� C�� <br /> I <br /> i , <br /> I <br /> � <br /> i <br /> ; Page 2 012 <br /> Revised 09/09/2014 <br />