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. . _ i <br /> � Baclkyvater Prevention Dev�ce <br /> �� Prop�rty Owner Rebat� Form <br /> Please verify the following ikems: <br /> am the owner of the property served by the side sewer�vhere the Backwater <br /> Prevention Device was installed. <br /> ❑ I worked with my contractor to determine the installation location for the Backwater . <br /> Prevention Device. I unders!and that the final decision regarding instailation location <br /> was mine. <br /> ❑ If the Backwater Prevention Device was installed on my property: <br /> o .I have been shown how to access, inspect; and maintain my device by my <br /> contractor . <br /> • I understand the City will not maintain the Backwater Prevention Device. I <br /> am exclusively responsible to maintain it and to keep it in good working <br /> order. <br /> • If I sell my property, I will make the buyer aware of the Backwater <br /> Prevention Device and the need to maintain it. <br /> Choose one of the following: <br /> ❑ As of now, my property i�as no downspouts or other onsite drainage that connects to - <br /> the side sewer upstream uf the installed Backwater Prevention DevicE. <br /> or <br /> still have downspouts or other onsite drainage that connects to the side sewer <br /> upstream of the installed Backw er-�r vention Device. I understand that leaving these <br /> connections means that risic of f ding from downspout or onsite drainage remains. <br /> � I accept that risk. <br /> Signature Uafe ��— ��7io f� <br /> Page 2 of 2 <br /> Revised 09/09/2014 <br />