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Backwater Prevention Device <br /> Property Owner Rebate Form <br /> Please verify the following items: <br /> �m lhe owner of the properly served by the side sewer�vhere the Backwater „ <br /> Prevention Device was installed. <br /> ��'�'dorked �vith my contractor lo determine the installation location for the Backw�ater <br /> Prevention Device. I understand ihat ihe finai decision regarding installation localion <br /> was mine. <br /> f the Back�vater Prewntion Device was installed on my property: I <br /> • I have been shown how to access, inspect, and maintain my device by my <br /> contraclor <br /> • I undersland the City�vill not maintain the 13ackwater Prevention Device. I <br /> am exclusively iesponsible to maintain it and to keep il in good working <br /> otder. <br /> . If I sell my property, I will make the buyer aware o(the Backwater <br /> Prevention Device and the need to maintain it. <br /> Choose one of the following: <br /> �Q As of notv, my property has no dovenspouts or other onsite drainage that connects to <br /> flie side sewer upstream of the installed Backwater Prevention Device. <br /> or <br /> ❑ I stiil have do�vnspouts or other onsite drainage thal connecls to the side se�ver <br /> upstream of�he installed 13ackwater Prevenlion Device. I undersland that leaving lhese <br /> connections means that lhe risk of Oocdinc� (rom downspout or onsite drainage remains. i <br /> I accept that risk. <br /> Sigr�ature� Date ,�/��/1 -�, <br /> `"/ / <br /> � <br /> � <br /> � <br /> i <br /> Pagc 2 oi 2 � <br /> � <br /> � <br /> Revised 09109f2014 <br />