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i <br /> I <br /> ; <br /> � <br /> Backwa�:er Prevention Device � <br /> Property Owner Rebate Form ; <br /> , <br /> Please verify ths following items: <br /> [�I arn the owner o(the property served by tne side sewer where the Backwater ' <br /> F'revention Device was ;nstalled. ' <br /> [�I v:orked with my contraclor to determine the installalion location for lhe Backwater I <br /> Prevention Device. I understand that the final decision regarding installation iocation <br /> was tnine. ' <br /> [, If:he Backwater Prevenlion Device�vas installed on my properiy: � <br /> �� I have been shown how to access, inspect, a��d maintain my device by my <br /> contractor <br /> o i understand the City�vill not maintain ihe Ba�k�vater Prevention Device. I <br /> am exclusively responsible to mainiain it and to keep it in yood �vorking <br /> order. <br /> • If I sell my property, I will make the buyer aware of the Backwater <br /> Prevention Device and the need to maintain it. I <br /> Choose one of the following: � <br /> [_JI !1s of no�v, my properly has no do�vnspuuts or other onsile drainage that connects to <br /> the �ide sewer upstream of tne installed 9ackwater Prevention Device. <br /> or � <br /> ; j I still have downspouts or ofher onsite drainage that cnnnects to the slde sewer � <br /> upstream of lhe installed 6ack�vater Prevention f�evice. I understanc thal leaving these <br /> �onnechons means that lhe risk of floodin,y from �iownspout or onsite drainaye remains. <br /> i ar.cept thed risk. <br /> / �J J/ ,� ; <br /> Siqnature����U�f[�����_____^ Date � " /5 `�,� _ . <br /> i <br /> Page 2 of 2 <br /> � <br /> i <br /> I <br /> Rewsed o9;09r2n1d <br /> i <br />