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�� � Backwater Pr�vention Device <br /> Property Owner Rebate Form <br /> . ; <br /> Please verify the following it�ms: <br /> . �Cl I am the owner of the property served by the side sewer where the Back ater <br /> ��evehtion Device was installed. <br /> � I worked with my contractor to determine the installation location for the Backwater <br /> Prevention Device. I understand that the final decision regarding installation location <br /> was mine. ; <br /> IC[1 If the Backwater Prevention Device was installed on my property: <br /> -�' <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 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 /> C:hoose one of the following: <br /> �; As of now, my property has no downspouts or other onsite drainage that connects to <br /> the sic�e sewer upstream of the.installed Backwater Prevention Device. <br /> or <br /> ❑ I still have uownspouts or other onsite drainage that conr.ects to the side sewer <br /> upstream of the installed Backwater Prevention Device. I understand that leaving these <br /> connections means that the risl� of flooding from downspout or onsite drainage remains. <br /> I accept that risk. <br /> Signature ������ Date + �! �/z�r7 <br /> r <br /> Page 2 of 2 <br /> Revised 09/09I2014 <br />