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� ': �� Backwater Prevention Devic:e <br /> ,� <br /> Property Owner Rebate Form <br /> Please verify the following items: <br /> �I�am ihe owner of the property served by the side sewer where the Backwater <br /> Prevention Device was installed. <br /> � Il,worked with my contractor to determine the installation location for the Backwater <br /> Prevr.n(ion Device. I understand that the final decision regarding installation location <br /> was�mine. <br /> � <br /> �If the Backwater Prevention Device was installed on my property: <br /> • I have been shown how to access, inspect, and maintain my device by my <br /> coniractor <br /> • i understand the City will not maintain lhe Backwater Prevention Device. I <br /> am exclusively responsible to maintain il 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 Qevice and the need to maintain it. <br /> Choose one of the following: <br /> a <br /> ti A's of now, my property has no do;vnspouts or other onsite drainage that connects to <br /> the �ide sewer upstream of the instailed Backwater Prevention Device. <br /> or i <br /> ❑ I slill hav,e downspouts or other onsite drainage lhat r,onnecls to the side sewer <br /> upslr.eam o(ithe installed Qackwater Prevention Devir.e. I undcrsland thal leaving lhese <br /> coniicdions�means thal lhe risk of floodi�c� from downspout or onsite drainage remains. <br /> I accept that risk. <br /> (s_���a""riur""'�— C_�U�.6[a.0 -�j—Ca,�.�r�--�Dar'`eW+� 7��7 �S _ <br /> � Paye 2 of 2 <br /> Revisrd 09/0917014 <br />