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' Backwater Prevention Device <br /> ���� Property dwner Rebate Form <br /> Plaase ��erify the following items: <br /> [I am the owner of the property served by the side sevder u�here the Back�vater <br /> Prevent�on Device was installed. <br /> f�l worked v✓ith tny contractor to determine the installation location for the Backwater <br /> Prevention Device. I understand ihat the final decision regarding installation location <br /> was mine. <br /> J if the Backwater Prevention Device was installed on my propeRy: <br /> • I have been shown how to access, inspect, and maintain my tlevice by my <br /> contracror <br /> � I understand the City will not maintain the Backwater Prevention Device. I <br /> am exclusively responsible lo maintain i[ and to keep it in good working <br /> arder. <br /> • If I sell my property, I will make the buyer avdare of the Backwater <br /> Prevention Device and the need to maintain it. <br /> Choose one of the following: <br /> t[�, As of now, my property has no downspouts or other onsite drainage that connects to <br /> the side sewer upstream of the installed Backwater Prevention Device. <br /> or <br /> ❑ I still have dovdnspuuts or other onsite drainage that connects to lhe side sevder <br /> upstream of the installed [3ackwater Prevenlion Device. I understand that leaving tl��ese <br /> connections means that the risk of flooding from do�vnspout or onsite drainage remains. <br /> I ar.cept ihat risk. <br /> Srgnature �_ _ � �4�� _ Date_�- �l ���� (J <br /> Page 2 of 2 <br /> Rr_vi;ed 09/09/2014 <br />