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� Backwater Preve;ntion Device <br /> � Propertv Owner Rebate Form <br /> Please verify the following items: � <br /> ���I am the o�vner of the property served b the sidelsewer tvhere the Backwater <br /> vention Device was installed. Y I <br /> ;�ll,l��vorked with my contractor to determine the installation location for the Backwater <br /> ��evention Device. I understand that the final decision regarding installation location <br /> was mine. <br /> � <br /> ��If the 8ackv✓ater Prevention Device �vas installed on my property: <br /> • I ha��e heen sho�vn ho�v to ar,cess, inspeci, and mainlain my device by my <br /> contractor I <br /> • I understand the City will nol maintain the Backwater Prevention Device. I <br /> am exdusively responsible to maintain il�and to kee� it in good working <br /> crdor. <br /> • If I sell my property, I will make ihe buye{� a�vare of the Back�vater <br /> Preven(ion Device and the need to mainiain il <br /> � <br /> Choose one of the following: <br /> .9 <br /> (�As of now, my property has no dawnspouts or other onsite drainage that conne�ts to <br /> the side se�ver upstream of the insialled Backwater Prevention Device. <br /> or � <br /> i <br /> ❑ I still have downspouts or olher onsite drainage Ihat connects to the side sewer <br /> upstream of the instal(ed [3ackwater Prevention Devicei. I understand that leaviny these <br /> r.onnections means that the risk of flooding from downspout or onsite drainage remains. <br /> I accept ihat risk. <br /> �Si,qnafure=9 ,��1�Ui'%���'�_J�h.���_ �Dat7��" �� <br /> i.` , <br /> i <br /> � <br /> Page 2 of 2 <br /> Revised 09/0917014 � <br />