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� <br />n�'�T,. <br />Backvuater Prevention Device <br />Property Owner lRebate Form <br />Please �erify the following items: <br />+[�I am lhe owner of the properly served b, t�ie side sewer where lhe Gackwater <br />Prevention Device avas installed. <br />,[_ vorlced with my coniractor to determine the installation location for the 8ackwaler <br />�Preven,icm Device. I undeistand that ihe final decision regarding installation location <br />was mine. <br />/ <br />C[ r If the Backwater Prevention Device was installed on my property: <br />• I have been shovdn hovd tu access, inspect, and maintain my device by my <br />contracior <br />I understand the City will not maintain lhe Back�vater Prevention Device <br />am exclusively responsibie to maintain it and to keep it in good working <br />order. <br />. If I sell my.property, i�a�ill make the buyer aware of the Backwater <br />--------Prevention-Deviee and the need-to maintaimit----- - — <br />Choose one of the foliowing: <br /><� of now, my property has no downspouts or other onsite drainage that connects to <br />the side sev�er upstream of the installed Backwater Prevention Device. <br />or <br />❑ I still have duwnspouts or other onsite drainage that connects to the side sewer <br />upstrearr� of the installed Backvdater Prevenfion Device. I undersiand that leaving these <br />connectiuns means thai the risk of flooc;in� from doevnspout or or.site drainage remains. <br />I accept that risk. <br />�-Signature �.1� <br />;_ . <br />�;P�-�s�d n�;o�i2ola <br />�'�� Date <br />Page 2 0( 2 <br />