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Backwater Prevention Device <br />Property Owner Ftebate Form <br />Please verify the fnllowing items: <br />L�3'��'am the owner of lhe property served by the side sewer where lhe Backwater <br />Preuention De��ice was installed. <br />�I workeii with.my contraclor to determine the installation location for the Back�vater <br />Prevention Devico. I understand that the final decision regarding installation location <br />was ;mine. <br />�If the Backwater 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 responsi6le lo maintain it and to keep il in good working <br />order. <br />If 1 sell my property, I will make the buyer aware of ihe Backwater <br />Prevention Device and tho need to maintain it. <br />Choose one of the following: <br />� As o( now, my property has no dovmspouts or other onsite drainage that connecls to <br />t e side sewer upsiream of the installed f3ackwater Prevenlion Device. <br />or <br />� i� Still have downspouis or othcr onsitr, drainage ihat conner,ls to the sidc sewer <br />upstream of the installed Backwater Prevention Device. I undersi;: nd ihat leaving these <br />conner.6ons means that the risk of floodiny from downspout or onsit�� drainage remains <br />I acc�pt Ihat ri�sk.�, <br />Siynature_ <br />�e��:��d ns�osizoia <br />— _ _ _ __ Date <br />�-3 Is- <br />P3ge "1_ 012 <br />