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i <br /> Backwat�r Prevention Device <br /> � t�roperty Owner �ebate Form <br /> I <br /> Please verify the following items: I <br /> [�am the owner of the property served by the side se�ver�vhere the Backwater <br /> Prevention Device was installed. i <br /> �,'I worked with my contraclor to determine the instal ation location for ihe Backwater <br /> Prevention Device. I understand that the final decision regarding installation location <br /> �vas mine. <br /> [�'If the Back�vater Prevention Device was installed �n my property: <br /> • I have been sho�vn how lo access, inspe'ct, and maintain my device by my <br /> contractor � <br /> • I undersland the City�vill not maintain th� Backwater Prevention Device. I <br /> am exclusively responsible to maintain iljand to keep it in good working <br /> order. <br /> • I( I sell nry properiy, I vdill make the buyer aware of the Backwater <br /> Prevention Device and the need to main�ain it. <br /> Choose one of thc following: <br /> [�As of now, my property has no do��✓nspouls or olher onsite drainage that connects to <br /> the side sewer upstream o(the installed Backwater Pri vention Device. <br /> or <br /> ❑ I still have downspouts or other onsite drainage thai connects to the side sewer <br /> upstream of the installyd 13ackwater Prevention Device. I understand that leavin� these <br /> conneclions means lhat lhe risk oi flooding from downi pout or onsite drainage remains. <br /> I accept ihat risk. , <br /> � <br /> y i <br /> Signature���J1Z!', , , 'f��.,� Di fe� �/-/.5=/5—' - <br /> i <br /> I <br /> I <br /> ' Page 2 of 2 <br /> RevisPd 09109/201A <br /> i <br />