Laserfiche WebLink
� <br />� <br />Backwater Prevention Device <br />Property Owner Rebate Form <br />Please verit�� the following ifems: <br />� I am the ov��ner of the proper;y seroed by the side sewer �vhere the Backwater <br />Prevention Device was instalied. <br />� I vdorked with my contractor to determ�ne tf�e installation location for the Backwater <br />Prevention Device. I understand ihat the final decision regarcing installation location <br />v,�as mine. <br />� If the Backv�ater Prevention bevice was mstalled on my property: <br />• I have been shov,�n ho�v to access, inspect, and maintain my device by my <br />contractor <br />• I understand the City wili not maintain ihe Back��dater Prevention Device. I <br />am exclusively responsible to maintain il and to keep it in good ���orking <br />order. <br />• If i s211 my property, I v.�ill make the buyer aware of ihc Back�vate� <br />Preventicn De��ice and tne need to maintain it. <br />Choose one of the following: <br />� Hs of novd, my properly has no dolvnspouts or other onsite drainage that connects to <br />!he side se�ver upstream of the installed Backwater Prevention Device. <br />nr <br />❑ I still have do���nspouts or other onsde drainaye that connects to lhe side se�yer <br />upstream of the installed Bar.kwater Prevention Device. I undcrstand lhal leaving these <br />conner,tions n,eans lhat the risk of Flooding from downspout or onsite drainage remains. <br />I accept that risk. <br />_`�; " � � /� <br />Signature_ � / i����!i_ =—� <br />Revi�ed C9;09%2014 <br />, <br />Date �/ L`G r �� <br />Page 2 of 2 <br />