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BACKWATER VALVE INSTALLA"1'ION PkOCRAi�T <br /> INSTALLA'I'ION AU'1'HORI7,ATION FOltl�l <br /> l. Pcimissi�_i_n_to Ins >.c�. 'I'hc 0��7ier grants Pennission to the City and its contraclor to <br /> inspcet the plumbing and Jrainage of the O���ncr's property fm� thc purpose of <br /> detcnnining ��ficthcr a back��'ater valve should be installed. 'fhe Ciry and O�mer will <br /> cooperate to determine a n'u�tually agrecablc time for thc inspection. 'fhe inspc.:tion is at <br /> thc Cit}�'s solc cost. <br /> 2. Ii:ickwatcr Vah�e lnstallatir,n. "rhe City wiil rc��icw ihc results of the inspection and wiil <br /> dctermine whether a Uacl;e;sler val�•c should be installed. I3y signing this autliorization, l <br /> the O�+ner g v�ts the Citp and its conh•actor pern�ission lo install the baclavater vah�c if <br /> the City dctc min�� that u backv;�ter ��alve should bc inst:illyd. This iuslallation is at the <br /> CIltl�S SOIO Cl�SI. <br /> 3. Site Drainaqe. I� inspcctiun �l the propert�� identifes that there are do�tmspouts connected <br /> to die side sewer upstream of tl�e proposed i�ack�vater vah�e location tlte do�enspouts will <br /> Uc disco�mccteJ or re-routed do�vnstrcam of the back�eater vah�e. f�y signing this <br /> authoriiation, thc Owner grants the Cit}� and its contractor permission to access the <br /> O�ener's �xoperty to modify drainage connections. Drainage modification is at tl�e Ciq''s <br /> solc cost. <br /> O�V'NGR(S): <br /> �A�Lf/lai�/ � <br /> Signahirc: Signaturc: <br /> ;P�,�1�n�v� �rn� <br /> Printed namc: f'rintcd \amc: <br /> l�-� Z �� rC�rY� f�✓� <br /> Printcd Address <br /> `f7�- �� 3 (- 107 5 <br /> 1'houc Numbcc <br />