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I <br /> Backwater Prevei�tion Device <br /> �� Property Qwner Rebate Form <br /> Please �rerif the follo ' I <br /> y wmg items: <br /> �am the owner of the property served b�� the side I ewer where the Backwater <br /> Prevention Device was installed. ( <br /> i <br /> �worlced with my contractor lo delermine the insta lation location for the Back�vater <br /> Preventiim Device. I understand that the final decisioil regarding installation location <br /> �vas mine. , <br /> r <br /> � If the Backv✓aten Prevention Device was installed on my properiy: <br /> � • 1 have,�een shown how to access, inspect, and maintain my device by my <br /> contractor <br /> • I understand the City will nol maintain thi Backwater Prevention Device. I <br /> am exciusively responsible to maintain it and to keep it in good working <br /> arder. <br /> � <br /> • I( I sell my property, I will make the buye� aware of the Backwater <br /> Prevention Device and the need to main ain it. <br /> Choose une of the;following: � <br /> � As of now, my property has r.o downspouts or other onsite 9rainage that connects to <br /> �the side ::ewer upstraam of the installed Backwater Prevention Device. <br /> � <br /> , ! <br /> or i <br /> ❑ I slill Y�ave downspouls or other onsite drainage th�t connects to the side sewer <br /> upstream of the installed Back�vater Prevention Devir,e. i undersland thal lea�ing these <br /> connections means thaf the risk oF flooding from down�pout or onsite drainage remains. <br /> I accept that iisk. i <br /> I <br /> i <br /> i <br /> Siqnature ' .�� ���TJate ! 7 pi s .� <br /> , . i <br /> . <br /> 'i <br /> I � <br /> , � <br /> I <br /> i <br /> Page 2 of Z <br /> � <br /> � <br /> I�evised D9/i)912014 i <br /> , <br />