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i <br /> I <br /> Backwater Pr�vention Device � <br /> � <br /> Property Owner Rebate Form ; <br /> ! <br /> Please verify the following items; 1 <br /> am the owner of the property served by the side sewe�where the Backwater � <br /> revenhon Device was installed. <br /> worlced with my contrador to determine the installation location for the Backwater � <br /> Prevenlion Device, I understand that the final decision regarding installation locaiion ; <br /> was mine, i <br /> /� �1h� GF t�R`f <br /> If the Backwater Prevention Device was installed on my property: i <br /> . I have been shown how to access, inspect, and maintain my device by my <br /> � <br /> contractor � <br /> • I understand ihe City will noI maintain the Backwater f'revention 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 /> Choo one of the fallowing: ' <br /> As oF now, my property has no downspouts or olher onsite drainage that connects to i <br /> the side sewer upstream of the insfalied Backwater Prevention Device. <br /> or ; <br /> I <br /> �] I still have downspouts or olher onsito drainage that connects to lhe side sewer � <br /> upstream of fhe installed Backwater Prevention Device. I understand that leaving �liese <br /> conneclions means tliat the risk of flooding �rcm downspout or onsite drainage remains. ! <br /> I accept that risk. ' <br /> i <br /> __��L.��C92ti.YGLln-.+- Date ✓��'���,� ' <br /> Signature <br /> — — i <br /> i <br /> _ <br /> � <br /> E <br /> Page 2 012 � <br /> i <br /> Revised 09l091201A � <br /> , I <br />