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� I� � <br /> � Backwater• Prevention Device <br /> � a' Pr+�Perty Owner Rebate f orm <br /> � <br /> Please verify the following items: <br /> ��J�liam the owner of the property served by the s:de sewer tvhere the Backwater <br /> Prevention Qevice was installed. <br /> � <br /> ��I ,worked with my contrar,tor to determine the installation locaticn for the Backwater <br /> revention Device. I understand that the final decision regarding installation location <br /> was 'mine. <br /> [�I Iflthe Backwater Preveniion Device was installed on my property: <br /> • I have been shown ho��,� to access, inspect, and maintain my device by my <br /> , conlractor <br /> • I understand the City��,�ill not maintain ihe Backwater Prevention Device. I <br /> am exclusiveiy responsible io maintain it and to keep it in good working <br /> order. <br /> �� • ;f I sell my property, I will make the buyer av�are of the Backwater <br /> � Prevention Device and the need to maintain it. <br /> I <br /> Choose one of the �ollowing: <br /> �J%As of no�v, my property has no do�,vnspouts or other onsite drainage that connects to <br /> the side seever upstream of the installed Backwater Prevention Device. <br /> or � <br /> � <br /> ❑ I still have iiownspouts or other cnsite drainaye that connects to the side sevder <br /> u?stream of the inslalled [3ar,kwater Pre��ention Device. ! understand that leaving these <br /> conneclions means ihat the nsk of floodinq from drnvnspoul or onsite drainage remains. <br /> I �+r,cepf th��t risk. <br /> i <br /> �s�,,,3t�„��.���,f� __ t�.=li�, , - -, ��—l z,•, �: <br /> f — -----�Date S <br /> ; ------- <br /> � <br /> ; <br /> � <br /> , Page 2 of 2 <br /> Revisetl 09/09/2014 <br />