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i <br /> 1j <br /> i . <br /> Backwater Prevention Device <br /> Property Owner Rebate Form , <br /> Please verify the following items: � <br /> �] I am the owner of the property served by the side sewer where lhe Backwater � <br /> Prevention Device was inslalled. � <br /> Lj I e�orked vaith my contraclor to determme lhe installation lo�;aiion for the Backwater � <br /> Preven6on Device. I understand that the final decision regarding installation location � <br /> �.vas mine. <br /> If the Backwater Prevention Devir,e was installed on my property: <br /> . I have been sho�vn how to access, ins{iect, and maintain my device by my <br /> contractor <br /> • I understand lhe City will not maintain the Ciackwater Prevention Device. I <br /> am exdusively responsible to maintain il and to keep it in good working <br /> order. <br /> . I( I sell my property, I �vill make the buyer aware o(the Backwater <br /> PrevenUon Device and the need lo mainlain iL <br /> Choose one of the following: " <br /> [✓ As of now, my property has no downspouts or olher onsite drainage t'nat connects to ' <br /> the side sewer upstream oi Ihe installed Fiackveater Prevention Device. <br /> or <br /> � I still have downspouts or other onsite drainage lhat connects to ihe side se�ver <br /> upstream of Ihe inslalled Backwater Prevention De��icc�. I undersland that Ieaving thesc <br /> cor�nections means thai Ihe risk of tlooding from downspout or onsite drainage remains. , <br /> I accept that risk. <br /> , <br /> Signa[ Date _ <br /> i <br /> � <br /> Pagc 9 ot 2 �. <br /> Revised 0 910 912 0 1 4 , <br />