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In{���� V � <br /> UU �rau � <br /> BACKWA7'ER VALVE INS7'ALLATION FRpG����' <br /> INSTALLATION AUTHORIZATI�jI7��`��N* , <br /> I. Permission to Inspwt. 'fhc Owncr grants pcmiission to the City :tnd its conVactor ta <br /> inspcct the plumbing and drainagc of lhc Owncr's property fi�r thc purposc of <br /> dctcrmining whcthcr a back�vater v,dvc should bc installcd, 'I'hc City and Oimcr will <br /> cooperatc lo delemunc a mu;ually aerecablc lime lor the inspcction. Tltc inspcction is at <br /> tlic City's solc cost. <br /> 2. Backwater Val��e Installation. 7'he Cily will rcvic��� thc results of�he inspcction cmd will <br /> dctciminc �ahethcr a backwater valvc should be installcd. l3y signing lhis authorization. <br /> thc O��vier grants thc City vid its contractor pennission to ins�all the b�ick�vater valee if <br /> the CIf}' CICICfI111I1CS 1I181 8 �1;1CF.'�V2lCf \'B�Ve should be installed. 'Cliis insiallation is at dic <br /> C.II)''S SOIC COSI. <br /> 3. Site Drainaec, if inspection of the properl}' identifies thnt there are do�wispouts connected <br /> to the side sewcr upstream of the proposed backwatcr��alvc location the do��nspouts will <br /> bc disconnccted or re-routed do���istream of the backwater valve. By signing this <br /> authorization, the O��mcr grants the City and its contractor perniission to access the <br /> O�t�ter's propc�ty to ntadily drainagc conncctions. Drainagc moditication is at t�c City's <br /> solc cost. <br /> O�VNF,R(ti)• <br /> � ,� ,���I�����.��. ��n�l�l�e�.�-,�,U <br /> Si� turc: Signuturr. � <br /> J o(��� -s', l�'1 r C�-�sse:, 5�►tiut�n! �i 7�'t�Cl2�v"S�'N � <br /> Printcd Neunc: PrinlcJ Namr. <br /> `� �z0 / �r�''�z�� ,C�,e; �-vc>�'e/i� Gv/P. `Jb'zD� <br /> Printcd Address <br /> (jzs�- z5z - �S�i,� <br /> Phonc Numbcr " <br /> t <br /> � <br />