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i <br /> � , Backwater Preve�tion Device <br /> ��� Property Owner Rebate Form <br /> i <br /> i <br /> � <br /> Please verify the following items: � <br /> ��I am the o�vner of the property served by the side i ewer�vhere the f3ackwater <br /> Prevention Device was installed. � <br /> , . . <br /> < <I worked with my contractor to determine the installation location for lhe Backwater <br /> Prevention Device. I understand that ihe final decision regarding installation location <br /> tvas mine. � <br /> � � <br /> .If the Bacl<water;Prevention Device was installed on my property: <br /> • I have;been shown hov✓to access, insp�ct, and maintain my device 6y my <br /> contractor <br /> • I understand the City will not maintain the Backwater Prevention Device. I <br /> am exclusively responsible to maintain it�and to keep it in good working <br /> order. ' <br /> i <br /> • If I sell my property, I will make the buyeh avaare of the Back�a�ater <br /> Prevention Device and the need to main�ain it. <br /> Choose one of thelfollowing: I <br /> r.�As of no�v, my prloperty has no downspouts or othelr onsite drainage th2t connects to <br /> tlie side sewer upstream of the i��stalled [3ackwater Pr�vention Device. <br /> I I <br /> or ! i <br /> I I <br /> ❑ I still have downs,pouts or other onsite drainage tha�t connects to the side sewer <br /> upstream of the installed Backwater Prevention Device. I understand that leaving these <br /> connections means that the risk of ilonding from down'spout or onsite drainage remains. <br /> I accept that risk. i <br /> , ; <br /> � <br /> C=Signatu�i�=�..,�� ,------ �Date 3 •.3� ^ dDIS <br /> 1� i <br /> i I <br /> i i <br /> ; <br /> � � <br /> i <br /> I � <br /> � Page 2 e(2 <br /> i <br /> Revised 09109/2014 � <br />