Laserfiche WebLink
J Backwater Prevention Device <br /> Property Owner Rebate Form <br /> Please verify the following items: <br /> I am the owner�f the property served by the side sewer where the Backwater <br /> Prevention Device was installed. <br /> I��vorked with my contractor to determine the installation location for the Backwater <br /> Prevention Device. I understand that the final decision regarding installation localion <br /> was' ine. <br /> _ If the E�ackwater Prevention Device was installed on my property: <br /> • I have been shown how to access, inspect, and maintain my device by my <br /> contractor <br /> • I understand the City will not maintain the Dackwater Prevention Dovice. I <br /> am exclusively responsible to maintain it and to keep it in good working <br /> order. <br /> • If I sell my property, I will make the buyer aware of the Backwater <br /> Prevention Device and the need to maintain it. <br /> Choose one of the folfowing: <br /> / <br /> [j�F�s oF now, my property has no downspouts or other onsite drainage that connecls lo <br /> the side sewer upstream of lhe installed Backwater Prevention Device. <br /> or <br /> ❑ I still have dow�spouts or other onsite drainage that connects to ihe side sewer <br /> upsiream of the inslalled Backvdater Prevention Devir.e. I understand that leaving these <br /> conneclions means thal the risk of floodiny frorn downspout or onsite drainage remains. <br /> � accept Ihat risk. <br /> . <br /> / <br /> Signaturc �� �' 11 ` ��, 1� <br /> --��" — - �1�i < Date �- �S <br /> � <br /> P;ige 2 of 2 <br /> Revis��d 09/09/201A <br />