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i <br />` Backwater Prevention Device <br />� � Property Owner Rebate Form <br />� <br />Please erify the following items: <br />I�am the o�vner of the property served by the side sewer where the Backwater <br />Prevention Uevice was installed. <br />I,�worked with my contractor to determine the installation localion for ihe Backwater <br />Prevention Device. I understand thal the final decision regarding installation location <br />was��nin�. <br />,�ithe Backwater Prevention pevice was installed on my property: <br />• I have been shown how to access, inspect, and maintain my device by my <br />contractor <br />• I understand the City will not maintain lhe Backwater Prevention Device. i <br />am exclusively responsible to maintain it and to keep it in c�ood working <br />order. <br />• IF I sell my property, I will make the buyer aware of the Backwater <br />Prevenlion Device and the need to maintain il. <br />Choose on -of the following: � <br />s of naw, my property has no downspouts or olher onsite draina e that connects to <br />!the side sewer upsiream of the inslalled E3ackwater Prevention Device. <br />�of �` Nd�eoiU�U�c�e�% <br />or <br />L� I still have dowr spouts or other onsite drainage lhat connects to the side sewer <br />upsV,eam of the instalied Qackwater Prevention Devir,e. I understand that leaving these <br />conriections means that the risk of Nooding from do�vnspoui or onsite drainage remains. <br />I accept that risk. <br />� � <br />Signature__ 2, �� _ <br />Revised�091D912014 <br />Q��e a�o 1� <br />r���� 2 or z <br />