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Backwater Valve Installation Program <br /> Installation Authoriza*ion Form <br /> 1 Permission to Insoect. The Owner grants pennission to the City and its contracior to <br /> inspect the plumbing and dreinage oi the O�r�ner's property for the purpose of <br /> determining v;hether a back�vater valve should be inslalled ihe City and Owner wdl <br /> cooperate to determme a mutually agreeable time for the inspection. The inspection <br /> is at lhe Cdy's sole cost <br /> 2 Backwater Valve Installation. The City will revie�v the resWts of the inspection and <br /> will determine v.�hether a back�vater valve should be installed. By signing this <br /> authorization (orm, the O��mer grants the City and its conlractor permisswn to install <br /> the 9ackwater valve rf the City determines that a backwater valve should be instalied <br /> This mstallation is at the City's sole cost <br /> 3 Site Drainaqe. If inspeclion of the property identi5es that there are do�vnspouts <br /> connected to the side seeder upstream of the proposed backwater valve location, the <br /> downspouts will be disconnected or re-routed downstream of the back�vater valve. <br /> 6y signing this authonzation, ihe Owner grants the City and its contraclor permission <br /> lo access the Ovmer's property to modify drainage coonections Drainage <br /> mocification i5 at tha Ciry's sole cest . <br /> OWNER(S): � <br /> �'"���� • <br /> Signat ue: SignaWre <br /> `�--e�]cli:'r`�L �f�1il /({O� __ _ - - ---- <br /> Printed Name. � Printed Name: <br /> lJ lD �r��rd _ v�, -- -_ -- <br /> Pnnted Address CV•�'�,�,,f j-' �qJ./�- Date <br /> f��,� _ 3�3-- s'� 8'�1-- - - - _ -- <br /> Phone Number Email <br />