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� ' Backwatier Prevention Device <br /> � Propert�O Owner Rebate Form <br /> Please verify the following items: <br /> �I am the owner of the property served by the sitlr: sewer where the Backwater <br /> Prevention Device was installed. <br /> �I worked with my contractor to determine the installatio� locaticn for the Backv�ater <br /> Prevention Device. I understand that ihe final decision regarding installation location <br /> was mine. <br /> If the Backwater Prevention Device was installed on my property: <br /> � I hav� been shovdn how to access, inspect, and maintain my device by my <br /> contractor <br /> � I understana the City will not maintain the Backwater Frevention 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 v✓iil make the buyer aware of the Backwater <br /> Prevention Qevice and the need to mainlain it. � <br /> Choose one of the following: I <br /> [[��A,s of now, my property has no downspouts or other onsite drainage that connects to I <br /> lhe side sewer upstream of the installed Backwater Prevention Device. <br /> or <br /> ❑ I still have downspouts or other onsite drainage that connects to ihe side sewer <br /> upstream of the installed Backwater Prevention Device. I understand that leaving these <br /> connections rneans that the risk of flooding from downspout or onsite drainaye remains. <br /> I accept th�d risk. <br /> Siynature__��ft-��w ����'�4--di'�` Daie � � /� — �� ��, <br /> �J-- � <br /> � <br /> � <br /> I <br /> Page 2 0(2 <br /> Revisec109/0912014 <br />