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Backwater Valve Installation Program <br /> Installation Authorization Form <br /> 1. _r^erm�ssion to Inspect. The Owner grants permission to the City and its contractor to <br /> inspect the plumbing and drem�ge of the Owner's property for the purpose of <br /> determining whether a backwater valve sY�ould be installed The Gity and Owner K�ill <br /> cooperale to determine a mutually agreeable time tor the �nspection The �nspect�on <br /> is at the Cdy's soie cosl <br /> 2 Backwater Valve Installahon The Cily wdl ieview lhe resulls o`the inspection and <br /> :vill determine v✓hether a hackwater valve should be mstalled Eiy signing this <br /> authonzation form, lhe Ov:ner grants the Ci'y and its contractor permission to install <br /> ;he backwater valve if the Cily determines that a backvrater valve should be installed. <br /> T his installztion is at the City's sole cost <br /> 3 Site Drainaqe If inspechon o(lhe property identifies that there are downspouts <br /> connec;ed to the side se�ver upstream of the proposed backwater valve location, the <br /> downspouts wdl be disconnected or re-routed do�vnstream o(the back�vater valve <br /> �y signing this authonzation, the Owner grants the Cily and its contractor oermission <br /> to access the Owner's property to modify drainage connections. Drainage <br /> modification is at the City's sole cosL __, . <br /> � . � <br /> OWNER S): / / <br /> �� - <br /> �/ � ' <br /> /� ✓ / �',� .. <br /> Sign ture Sign i,u e: '`' <br /> � <br /> r <br /> �CG �(� �eP.�(� — ���.`P_£���/�-� <br /> Pnnicd Narne: Printed Nam <br /> /5�.; C�«��? ��P F: .� ��7�-`�— - <br /> J_ - <br /> I'nn�ed Address Date <br /> ����=-�3 yG>-_7�2S -- - bl��;�yU„ds�i�����ha1��1q�I.c'b•�-� <br /> Fhonc Number Emad <br />