Laserfiche WebLink
: � <br /> Backwater'Prevention Device <br /> Pr�perty Owner Rebate Form <br /> Please vcrify the following items: <br /> ;V�I iam the owner cf the property served by the side sew2r where the Backwater <br /> Prevention Devicr. was installed <br /> �v�orked with my contraclor to detennine the instaliation location for the Backwater <br /> Prevention Uevice. I understand that the final decision regarding installation location <br /> avas mine. <br /> [�If!the Backv�ater Prevenlion Device was inslalled on my property: <br /> • I have been shown ho�,v to access, inspect, and maintain my device by my <br /> ' contractor <br /> • I unders;tand the City v;ill not maintain the Backwater Prevention Device. I <br /> am exclusively.responsible to maintain it and to keep it in good vrorking <br /> order. <br /> : • If I sell my property, I vdill make the buyer av✓are of the Bac�c�vater <br /> � Prevention Device and the need to maintain it. <br /> Choose one of the �ollowing: <br /> ii <br /> [J As of now, my p�operty has no dovrnspouts or other onsite drainage that conne;.ts to <br /> the side sewer upstream of the installed Backwater Prevention Device. <br /> or <br /> ❑ I s�till have dovanspouts or other or�;ite drainage that connects to the side sewer <br /> upsUoam of the installed Bachwater Prevention Device, I understand th2t leaving these <br /> connections means that the risk of flooding (rum downspout or onsilc� drainage remains. <br /> I accepi that risk. <br /> /i <br /> ��Srgnatif��<�•/1��� — <br /> I �Datc��/-/4 <br /> � � <br /> � <br /> � <br /> Pa9e 2 of 2 <br /> Revised 09109/201q <br /> j <br />