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i <br /> Backwater Prevention Device ° <br /> r Propertv Owner Rebate Form <br /> Please verify the following items: � <br /> I <br /> I-�am the owner of ihc property served by the sidc sewer where the Backwatc:r 1 <br /> Prevenlion Device vdas installed. � <br /> i" <br /> ,_✓'� I v,�orked v,�ith my r,ontractor to dotermine the installation locafion for lhe Backwater � <br /> Prevention Device. I understand that the final c'.ac;ion reg2rding installation location ' <br /> was mine. <br /> (��If the f3ack�valer Prevention Uevice was inslalled on my property: : <br /> • I have heen sf own hn��a to :�ccess, inspect, and rnaintain my device by my <br /> contractor <br /> • I untlerstand th� City�vill nol maintain ttie Rackv,�ater Prt�vention Device. I <br /> arn exclusively rc�sponsible to maintain it and to keep it in �ood working <br /> order. <br /> • I( I sell my property, I will make the buyer aware of the Backwater <br /> Prevention Device and the need to maintain iL <br /> Choose one of the following: <br /> !�As of now, my property has no do��mspouts or other onsite drainage that connects to , <br /> the side sewer upstream of the insialled ��ckv�at�r Prevention Device. <br /> or <br /> I_� I still hav� downspouls or other onsite drainage thal connecis to the side sewer <br /> upslream of Ihe installed Back�aater Prevention Device. I understand that leaving these <br /> r.onnect�ons maans that the risk of flooding fiom downspout o! �nsite dreinac�e remains. <br /> I accept thal risk. <br /> I� � <br /> SignaturP O� b! _ Date Z - �v - I S <br /> � <br /> Page 2 of 2 <br /> � <br /> Revised p9109!201q <br /> i <br />