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047rBackwater Valve Installation Program <br /> Installation Authorization Form <br /> 1. Permission to Inspect. The Owner grants permission to the City and its contractor to <br /> inspect the plumbing and drainage of the Owner's property for the purpose of <br /> determining whether a backwater valve should be installed. 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 Installation. The City will review the results of the inspection and <br /> will determine whether a backwater valve should be installed. By signing this <br /> authorization form, the Owner grants the City and its contractor permission to install <br /> the backwater valve if the City determines that a backwater valve should be installed. <br /> This installation is at the City's sole cost. <br /> 3. Site Drainage. If inspection of the property 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 authorization, the Owner grants the City and its contractor permission <br /> to access the Owner's property to modify drainage connections. Drainage <br /> modification is at the City's tole cost <br /> OWNER(S): <br /> 11.7A. ,wo e <br /> Signature: Signature: <br /> A,—/ te.[.;Y "7 ire Y <br /> Printed Name: Printed Name: <br /> .R./t4•.414 <br /> fDXoV 9Z//3i - 98/z y //-/ •/L/ <br /> Printed Address Date <br /> ,co, 0-G/1./,A'r. <br /> Zola -7e/1- di/3.f` inky (2 (,112��Ar IOC,.elo.. .- <br /> Phone Number Email <br />