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Backvrater Prevention pevice <br /> Property Owner Rebate Form <br /> Please verify the following items: + <br /> I am the owner of tt e property served by lhe side seever where the Backwater „ <br /> { <br /> Prevention Device was installed. <br /> �v,�nrked with my contractor to determine the installalion location for the Backwaler <br /> Prevention Device. I understand that the (inal decision regarding installalion location ` <br /> vdas rnine. � <br /> t <br /> �—J�If the Backwater Prevention Device w�as instailed on my property: <br /> . I have been shown how to access, inspect, and mainlai� my device by my <br /> contractor <br /> . I understand lhe City����ill not maintain the Backwater Prevenlion Device. I <br /> am exclusivr.ly responsihle to maintain it and io keep il in good workiny <br /> order. <br /> • If I sell my properly, I v��ill make the buyer aware of the Backvdater <br /> Prevention Devir,e and the need to maintain it. <br /> Choose one of the foilowing: <br /> [v�As of no�v, my property tias no downspoids or other onsite drainage ihat conn�cts to <br /> the side se�a�er upstroam of the installed Rack�vater Prevention Device. <br /> or <br /> ❑ I still have do�vnspouts or other onsite drainage that connects to the side sewer <br /> upstream of the installed [iack�vater Prevention Device. I understand ihal leaving these <br /> connections means that the risk oi(looding from downspout or onsite drainage remains. <br /> I accept that risk. <br /> Signature i�G`C,� (" �-.. . �� Date _�5 �f-r'/� �� <br /> 1—�-------- <br /> P2ye 2 of 2 <br /> R�vised 09/091201d <br />