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Backwater Valve Installation Program <br /> Installation Authorization Form <br /> 1. Permission to Insoect. The O'rrner grants permission to the City and its contractor to <br /> inspect the plumbing and drainage of the Owners property for the purpose of <br /> determimng whether a backwater valve should be instafled. The City and Owner will <br /> cooperate to determine a mutually agreeable time for the inspection. The inspection <br /> is at the City's sole cost. <br /> 2 Backwater Valve Installatron The City wlll revlew the results of the inspeciion and <br /> will determine whether a backwater valve should be installed. By signing this <br /> authorization torm, the Owner grants the City and its conlractor permission to install <br /> the backwater valve if the C�ty determines that a backwater valve should be installed. <br /> This installation is at the City's sole cost. <br /> 3. Site Drainaqe. If Inspection of the prope�ty identifies that there are downspouts <br /> connected to the side sewer upstream of the proposed backwater valve location, the <br /> downspouts will be disconnected or re-routed downstream of the backwater valve. <br /> By signing this aut!�orizalion, Ihe O�vner grants the City and its contractor permission <br /> to access the Owner's property to modify drainage connections Orainage <br /> modification is at the City's sole cost <br /> OWNER(S): <br /> r y� <br /> � ` /'/ <br /> Signatum Signatur : <br /> S�ADGEY iYl. SEL� �2��t c�1C_l'�Z� <br /> � Printed Name: Printed Name. <br /> ��}a2 �/1�4wD Ai/� �O'- /f�- �`�"' _ <br /> Printed Address Date <br /> � �f'25- Y 7(0- `1957 �/ravs��rzt��u►rsc�A-s.cc..� <br /> Phone Numbcr Email <br />