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Backwater Valve Installation Program <br /> �. Installation Authorization Form <br /> t. Permission to Inspect Ti.� Owner grants permission to th= City and its contractor to <br /> inspect the plumbing and drainage of the Ov�ner's property for lhe purpose of <br /> tlete�mining v�hettier a 6ackv�aler`valve should'be installed-The City and'Owner will <br /> r.00perate to determine a mutually agreeable tii�e for the inspection The inspection <br /> is at the City's sole cost. <br /> 2 Backwater Valve Installa;ion The City will review ihe results of the insoection and <br /> wih det?rmme whether a back�vater valve should be installed. By signing this <br /> authorization form, the Owner grants the City and its contraclor permission to install I <br /> the backwater valve rf Uie City determines ihat a backwat=r valve should be installed. <br /> This installation is at the City's sole cost <br /> 3 Site Uramaoe. If insper!{on of the property iden6fies that there are dovmspouts <br /> connected to the siae sewer upstream of the proposed backwaler valve iocatiun, the <br /> dov.�nspouts will be disconn�cted or re-routed downstream of the backwater valve. <br /> By signmg this authorization, ihe Ovmer granis the City and its contractor permission <br /> to access the Owners property to modify dreinage connecti�ns. Drainage <br /> moddication is al the City's sole cost <br /> OWNER(S): <br /> s,��� �_ �����-- <br /> s���,�t��e - — <br /> /1�����r -- �1'�, �Y--- -- <br /> Pnnted Name Pnnted Nam r <br /> �in NL.l..drl <br /> �O�_�yi3/ - __ 98.z� _ // � �i�/ <br /> Pnnted Address Date <br /> /SO/ G.c.�,//J�n. / <br /> ZOCa-�y1 y�,�.�_ —_ _ �iit/�_��/iY/,j�w,�(I-�'o.� <br /> Phnne Numher Email <br />