Laserfiche WebLink
4E,�, Backwater Prevention Device <br /> Property Owner Rebate Form <br /> �Please verify the following items: <br /> pI am the owner of the property served by the side sewer where the Backwater <br /> Prevention Device was installed. <br /> I tivorked with my contractor to determine the installation location for the Backwater <br /> revention Device. I understand that the final decision regarding installation location <br /> was mine. <br /> it the Backwater Prevention Device was installed on my property: <br /> • I have been shown ho�v 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, l will make the buyer aware of the Backwater <br /> Prevention Device and ihe need to maintain it. <br /> ,' <br /> Choose one of the following: <br /> �] As of now, my property has no downspouts or other onsite drainage that connects to <br /> lhe side sewer upstream of the installed Backwater Prevention Device. <br /> or <br /> ❑ I stil� have downspouts or other onsite drainage that connects to the side sewer <br /> upstream of ihe installed Backwater Prevention Device. I understand that leaving these <br /> connections means that ihe risk of(looding from do�vnspout or onsite drainage remains. I <br /> accept that risk. <br /> � , ) ` �.i <br /> C Signature '�,�.z�,• . % �� Date -�- <br /> � r / <br /> Page 2 of 2 <br /> Revised 09/0912014 <br />