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� � ' Backwater Prevention Device <br /> � ' Property Owner Rebate Form <br /> Please verify the following items: <br /> �sm the owner of the property sen�ed by the side sewer where the Backwater <br /> Prevention Device was installed. <br /> I worked v✓ith my contractor to determine the installation location for the Backwater <br /> Prevention Device. I �mderstand thal the final decision regarding installation location <br /> �vas mine. <br /> [j�the E�ackwater•Prevention Device was installed on my property: <br /> • I have�been sho�vn how to access, ins,,ect, and maintain my device by my <br /> contractor <br /> • I undeFstand the City will not maintain the Back�vater Prevention Device. I <br /> am exclusively responsible to mainlain it and to keep it in good working <br /> order. <br /> . If I sell my properly, I will make the buyer aware of the Backv�ater <br /> Prevention Device and the need to maintain it. <br /> Choose one of the ifollowing: <br /> ; As of now, my property has no downspouis or other onsite drainage that connects to <br /> the side sewer upst iearn of the installed Backwater Nrevention Device. <br /> or <br /> ❑ I still have downspouts or other onsite drainage that connects to the side sewer <br /> upstream of;ne instalied Back�vater Prevention Device. I unders(and that leaviny these <br /> conneclioi;s means that the risk of iloodiny irorn downspout or onsile drainage remains. <br /> I ,ept ihat risk. <br /> ^J � <br /> � / <br /> / � / ��5�-- <br /> / � _ <br /> Signature� , .' ; ___ _ __ Date <br /> ---�--� <br /> Payc 7. oi 2 <br /> Revised 09/09/2014 <br />