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io � _ _.' � <br />i��l�N�I�G1vICU <br />, � o�u T QV U 6 2013 D <br />BA.CKWATT,R VALVE AUTH ZA IOiV <br />Permission �o insnect. The Owner granis permission to the City an�jiYs•I�odVac�i t�j{S <br />�nspcct the plumbing and dra�n<.ge of the Owncr's propert}� for the puipose of gathering <br />information r�garding whethcr a back�vater v�lvc shoulci bc installed. The City and <br />Owncr �vill cecperatc to detcnnine a mutually agrccablc timc for the inspection. The <br />inspection is at lhe City's solc cost. <br />2, Radavatcr Vah�c. <br />A. Cil}� Revic�v oC Inspcction and Pcnnission to Tnstall F3ack�vater Valve. 7'he City <br />will rcvicw thc results of thc inspcclion and wifl dctcnninc whcthc baclavalcr <br />valvc shoulcl bc inslallcd. By s;gning this autf�orization, thc Otvn,r granls thc <br />City and its conhactor permission lo inslnll the baclat�ater valvc if the City <br />detcnnincs ll�at a backwatcr valvc shoidd bc inslallcd. This installation is at thc <br />City's sole wsL <br />�3. Other llevicu. Thcrc may Uc otlter deviccs that provide ��s good as (or grcatc!) <br />protr.ction tlu�n a bacicw:der v:dvc. 13y signing this. authorizalion, ihc O�vncr <br />gr�nts Ihc City and its contr.�cror permission to uistall thc oUicr dc��icc if tl�c City <br />dcicrmines that it should Uc installcd. This inslallatio» is at thc Cily's solc cost. <br />Howcvcr, if the Owner desires inslallation of the olher device, but thc City has <br />determined to only install a bacicwater valve, then the Owner may install the ollrer <br />devir,c, and the City wili rcimburse ttie Owner up to tlie installation cosL oP thc <br />Uaciavntcr valvc. <br />c. r��i���� n9�intcnancc. Upon installation, tltc backwatcr valvc or othci� dcvicc is the <br />Owncr's property. Thc Owncr is cxclpsively responsihlc to mainL•�in it. <br />3. Othcr Rccommcndcd In�rovements. A(tcr thc completion of lhe inspcction, die City <br />m;+y providc [lic Otvner rvith a list of olhcr rccommendcd improvemcnts to thc properly's <br />plumbing and drainagc syslcros. "I'hc Owncr is responsihlc for dctcnnining whcthcr tn <br />impicmcnl dic recotnmeud��tions on tlie list and for paying for the implcmcntalion. <br />OWNT,R:______ ����TV_I. -- <br />p.,�..�,,,r ti.., � <br />Signatu c: Signalurc <br />IY�G R.a- � CY A <br />Prinlcd Nsmc: Printcd Namc: -- <br />P. o. 6o k t�l �l-t C'vt.A-d-�^� , uJ N �i ii 2a � <br />Printcd Address: -- <br />'� PN.�S � c�z- q-U�'(�-135 5 o�F f�'1!''v'"� �- 0 242 -13 ► 5 <br />i <br />� t ooz r�. P�.� pe . <br />. .��,�,ec-.�r � �v,�s �t � 8 Zp3 <br />