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. � <br /> Backwater Prev�ntion Device <br /> Property Owner Rebate Form <br /> Please verify the following items: <br /> �[1� �am the otvner of the property served by the side sewer�vhere ihe Backwater <br /> Prevenlion Device was installed. � <br /> : :^'p orked with my contractor to determine the inslallation location for the Backwater , <br /> Frevention Device. I understand that the final decision regarding installation location � <br /> was mine <br /> --�the Backwater Prevention Device was installed on my property: <br /> �� � I have been shown how to access, inspec�, and maintain my device by my <br /> • contractor <br /> • I undersiand the City will not maintain the Backwater Prevention Device. I ` <br /> am exclusively responsible to maintain it and to keep it in good working i <br /> order. <br /> • Ir I sell my property, I wili make ihe buyer aware of the �ackwater I <br /> Prevention Device and the need to maintain it. I <br /> Choose one of the following: i <br /> :�s� <br /> �s of notv, my property has no downspouts or other onsite drainage that connects to � <br /> �e side sewer upstream o( the installed aackwater Prevention Devi�e. ' <br /> or ( <br /> � <br /> [j I slill have drnvnspouis or other onsite drainage that connects to ihe side sewer I <br /> upslream of the inst�lled f�acktvater Provention Device. I understand ihat leaving these ! <br /> connections mea�ns that lhe risk oi ilooding from downspout or onsite drainage remains. � <br /> I accept that risk. <br /> � <br /> i <br /> �r�Signa:tiir� .}�...�?---• — — -----yDafe'--� 2ji l�_ <br /> —f <br /> I <br /> � � <br /> � Page 2 of 2 <br /> I <br /> Rcwsed D9109l2D1d ' <br />