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Backwater Prevention D�vice <br />Property Owner Rebate Form <br />Please verify the following items: <br />�,�✓��I am the o�;�ner o` 1hE property s�n�d by the side se�ver u�here the Bachv;ater <br />Nrc�vention Device was installed <br />r[ �'I �vorked wlih my contractor to d��Iern�ine the installation �ocation for the Back�valr,r <br />Prevention Device I understand that tne final decision regarding inst,allalion loc�:tion <br />�.vas mine. <br />���he Bar,kwater Prevention Device was inslalled on my pioperty. <br />' • I have been shown ho�v to access, inspect, and maintain my device by my <br />cnntracior <br />I understand the Ciry v:ill not maintain the Bar,k�vater Prevention Device. <br />arn exclusively responsitile to maintain it and to keep it in good working <br />order. <br />if I soll my property, I �:�dl make th� buyar a�vare oF ih� f3ackv.�ater <br />Preventio� Devic� z�:id ihc necd t� m�'rta�n it <br />Choose one of the fallowiny: <br />��As of nocd, my property has no do�vnspouts or other onsde dramage �'��at r.cr�,n�ecis fo <br />the side sewer ups'ream of the �nstalied Backwater Prev�ntion Devir.e <br />or <br />i�, I still i�,ave downspouls or other onsde drainagc that connects to the side sewer <br />u�sV��am of the instailed FS.ir.k��:oler Predenlinn De��:ce I understand ihat leaving these <br />cannections means lhat fhc iis; uf fluu�:my .`rimi doe•;nspuut oi onsite drainage remoins. <br />I ,�cceol tht�l ri.^,k <br />i <br />Signr�(ure ��� . <br />i�«�,<<,d n�„�,�,� �ota <br />o3r� rht1�R�.14_ i(� '2015 <br />,--. <br />i��.�> �,,� <br />