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i <br /> o [�C�C�d1I�l� ' <br /> �n� � D <br /> �.�a�� a 12ui� L� <br /> RACKVVATER VALVE INSTALLATI(t�1(,L'I� ��Z�S I <br /> �' 1NSTAi.LA7'ION AUTHORllA'TIO�iF'�� ' - � <br /> � <br /> I <br /> I. Permission m inspect. The On�ner granls permission to ihe City and iis contcictor to , <br /> inspect the plumhing and drainage of the O\5'IICf'S property li�r thc put��ose of j <br /> detci7nining whe[her � hackwater valvc should b� inslallcd. 'llic City ancl Owner �ti�ill <br /> cooperatc to dctennine a mutuaUy agreeable time ior Ihe inspection. llie inspection is at ; <br /> the Cilv's sole cosl. � <br /> . � <br /> Z. Hack�vater Valve Installa_�un. lhe Cih� ��ill revicw ihc results of the inspectio�� and will i <br /> detcnuine whetlicr a bac!«��ater ��alve should be installed. 6y signing Ihis a�t�orir:+tion, i <br /> the Owner grants thc Cit} and its conlractor perntission to inslall tlie baclava[cr �a! „ if� � <br /> the City dctermincs th�t a back���atcr ��alve should be installed, 'I'his installation :� . he <br /> City's sole cost. i <br /> 3. Sitc Drainat�e. lf inspection �,`the property idcntifes that thcre are downspc,�rts conrected � <br /> to the side sewer upstrcam of ihe proposecl Uackwater ��alvc iocation the do��nspou�; . �II <br /> he disconnected or re-routed do�mstrcam of the Uack�vater valve. B}� signin� this <br /> authorization, the Owner grants the City and its contrnctor permission to access �he ' <br /> O���ner's property to modify drainage connections. llrainage modific;rtion is at the City's t <br /> SUIC CUSI. �` <br /> 1 <br /> i <br /> i <br /> U\\'NER(S): j <br /> c <br /> Tr�wn..li t� J „A�S�� / �,l�-f� ���.E(=� � <br /> Signahirc: Signalurc: � <br /> �<�nn�_L Q .� o.t� ���v/ /� S<' �� I <br /> � <br /> Printed Name: Printed Name: � <br /> �li'UG� /��c.��,�r'//r°r� �ire I <br /> Printcd Address <br /> � <br /> "7'�_7 ' �5�- ��� v i <br /> � <br /> � <br /> Phone A'umbcr j <br /> ! <br /> i <br /> i <br /> � <br /> . i <br /> 1 <br />