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r ' <br /> BACKWATER VALVE INSTALLATION PROGRAM <br /> INSTALLATION AUTHORIZATION FORM <br /> 1. Permission to Inspect. The Owner grants permission to the City and its contractor to <br /> inspect the plumbing and drainage of the Owner's property for the purpose of <br /> determining whether a backwater valve should be installed. The City and Owner will <br /> cooperate to determine a mutually agreeable time for the inspection. The inspection is at <br /> the City's sole cost. <br /> 2. Backwater Valve Installation. The City will review the results of the inspection and will <br /> determine whether a backwater valve should be installed. By signing this authorization, <br /> the Owner grants the City and its contractor permission to install the backwater valve if <br /> the City determines that a backwater valve should be installed. This installation is at the <br /> City's sole cost. <br /> 3. Site Drainage. If inspection of the property identifies that there are downspouts connected <br /> to the side sewer upstream of the proposed backwater valve location the downspouts will <br /> be disconnected or re-routed downstream of the backwater valve. By signing this <br /> authorization, the Owner grants the City and its contractor permission to access the <br /> Owner's property to modify drainage connections. Drainage modification is at the City's <br /> sole cost. <br /> OWNER(S): <br /> Si re: Signature: <br /> Pri Name: Printed Name: <br /> �Co/Z Cke- 14iv-e <br /> Printed Address <br /> 4/ZS Zq q q 3 <br /> Phone Number <br />