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I <br /> � '' Backwater Prevention Device <br /> �� � . Property Owner Rebate Form <br /> , <br /> � � <br /> Please ver,ify the following items: <br /> �I am the owner of the property served by the side sewer where the Backwater <br /> revention�Device was installed. <br /> �, <br /> I�worked with my contractor to determine the installation location for the Backwater <br /> Pre 'ention Uevice. I understand that the final decision regarding installalion location <br /> was;minn. <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 /> , cor' �r <br /> , • I ui.. �tand the City will not maintain the Backwater Prevention Device. I <br /> am exchisively 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 /> i <br /> Choi se one of the following: <br /> �A�s of not�✓, my properly has no downspouls or other onsite drainage that connects to <br /> the side ;;ewer upstream of the installed Backwater Prevention Device. <br /> � <br /> or . <br /> ❑ I still have downspoufs or other onsite drainage lhat conneols to the side sewer <br /> upstceam of�the installed f3ackwater Prevention Device. I undersland that leaving these <br /> connections means thal lhe risk of flooding from downspout or onsite drainage remains. <br /> I accept thaf risk. <br /> ,Signature : ������_'<�-- ,- — � �c— <br /> - _., _ __ Date � > <br /> i i <br /> i <br /> ', <br /> � Page 2 ot 2 <br /> Revised 09ID912014 <br />