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Backwater Valve Installation Program <br /> Installation Authorization Form <br /> 1 Permission to Insoect. Thc Owner grants permission to the City and its contractor to <br /> inspect the plumbing and draina�e of the Owner's property for the purpose of <br /> determining whether a backvdatei valve shoutd be instailed. The City and Owner���itl <br /> cooperate to determine a mutually agreeable time tor the inspection The inspection <br /> is at the City's sole cosL <br /> 2 Backwater Valve Installation The Ciry will review the results of lhe mspection and <br /> will determine whether a backwater valve should be instailed. By signing lhis <br /> authorizalion form, the Owner granls the City and its contractor permission to install <br /> the backwater valve if ihe City determines that a backwater valve should be installed. <br /> This installation ic at the Cit��'s sole cost. <br /> 3 Site Drainaqe. If inspection of the property identifies ihat there are dovonspouts <br /> connected to the side se�ver upstream of the proposed backwater valve location, the <br /> downspouts evill be disconnected or re-routed downstream of the backwater valve. <br /> By signing tnis authorization, the Owner grants the City and its contractor permission <br /> lo access the Owner's property to modify drainage connections. Drainage <br /> modification is at lhe City's sole cost. <br /> OWNER(S): � <br /> �GV✓ C�/�.� <br /> 5ignature: � Signalure: <br /> �li �h ,,,:� � I��:c�l _ - <br /> Prinled Name: Printed Name: <br /> ��LS �; ra-�tc�- A'UP� �b —� �l /4 <br /> Printed Address Date <br /> N7-5- Z5 = --4t�a�'- __ -- - <br /> Phone Number Emad <br />