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ev -s <br />Backwater Prevention Device <br />Property Owner Rebate Form <br />P,lease verify the follolving items: <br />��I am the owner of the pro�;erty sE�rved hy the side seia�er �vhere the f3ackwater <br />Prevention Device was installed. <br />/.. <br />f� I worked vdith my contractor to determine the installation Iocation for the F3ackvdater <br />�Prevention Device. I understand that the final decision reyarding installation location <br />was rtiine. <br />�y+ If th� Eiack�•eater Prevention Device was installed on my property <br />• I have been shown ho�v to access, inspect, and mairtain my device by my <br />conlractor <br />• I undersland lhe City will not maintain the Back�;�ater Pr2vention Device. I <br />ain ^.xclusively responsible lo maint� -�t and to keep it in good wo�king <br />order. <br />• if I sell my property, I v�ill make lhe buyer a�vare o: th� Bacicv�ater <br />Prevention De��ice 2nd the need to main!ain It <br />Choose�on`e of the followino� ` <br />i <br />� As of now, my property h�s no downs, ouis ur otrer �nsite drainaa� lhat conrects lo <br />the side sev��or upstream of tfie installed B��ckavater Prevenlion Device. <br />or <br />�-] I still have docrnspouts or olher onsil��� drainage thal connects to the side sewer <br />iipstrean'� of the insfo:led Bar.kvda,er Prceention Ucvice I�.�nd��i�dand ihat leaving lhese <br />connections m�;ans Uust tl��e iisk of floodiny from do�vnspoul ur unsitc� drainaye remain.=,. <br />I ar,cepl that risk. <br />Siyn�lt�irr, _. <br />Revisad 09 /0 912 0 1�1 <br />���,� .. � �l)�ito �' ��; <br />�- <br />i',:;�e'l. 012 <br />