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� <br /> � ` Backwater Preve tion Device <br /> ' Property Owner �ebate Form <br /> Ple se verify the following items: <br /> i <br /> { �)I;am the owner of the property served by the side sewer whe�e the Back�vater <br /> Prevention Device was insialled. <br /> �sl worked with my wntractor to determine the installation location for the Qackwater <br /> revention Device 1 understand that the final decisior� regarding installation location <br /> was ' iine. <br /> U �If;the Backwater Prevention Device was installed on my property: <br /> � 1 have been shown how to access, inspect, and maintain my device by my <br /> contractor <br /> • I understand the Cily will not maintain the Backwater Prevention Device. t <br /> am exdusively responsible to maintain it��and to keep it in good working <br /> order. � <br /> • If I sell my properly, I will make the buyel( aware of the Backwater <br /> Prevention Device and the need to mainfain it. <br /> Ch ose one of the following; I <br /> �As o( now, m I <br /> A y property has no downspoufs or other ensite drainage that connects to <br /> the side sewer upstream of the installed f3ackwater Pri vention Device. <br /> or I <br /> [ I slill have downspouts or other onsile drainage th It connects to the side sewer <br /> upstream of the installed Backwater Prevention Qevic�. I understand that leaving these <br /> conneclions means that the risk o(flooding from down� pout or onsite drainage remains. <br /> I :�ccept thal risk. � <br /> � <br /> Signa�tureJ'i _� _..----•���,c�'.�-�_ �Dat� � � ��-S <br /> � <br /> Page 2 o(2 <br /> Re��ised 09/09/2014 <br />