Laserfiche WebLink
r. ; <br />� <br />Backvvater Prevention Device <br />Property Owner Rebate Fort'�i <br />Please verify the following items: <br />vi i a^? ihc owner of the properry served by the side sewer where the Backwaler <br />Prevention Device was installed .'4'. I <br />��J�I �a�orked �vith my contractor to delermine Q�e'installation location for the Backwater <br />I'revention Device. I understand that the final decisiori regarding installation location <br />�„as niine. • <br />�� if the l3ackwater Prevenhe,n De��ice �vas installed dn my property: <br />• I have been sho�vn ho��,� to ar,cess, inspect, and maintain my device by mye <br />coNractor j � , <br />I understand the City will nol maintain the l3ackveater Prevention Device. I <br />�m exdusively responsibte to maintam it and to keep it in good �vorkmg <br />order. <br />If I sell my properry, I v✓ill make lhe buye� aware of the Back�valer <br />Prevention Device and ihe need to maintain it. <br />Choose one of tlie following: <br />[✓� As of now, my property has no downspouts or other onsite drainage that connects to <br />the side sev;er upstream of the installad Rackwater Prevention Device. <br />'i <br />or I�, <br />�[� I still hav�►{;o�praspouts or olher onsite draina�e th�t connects to the side sewer <br />.� upstream of the installed Uar;kwater Prevention Devic� I undersland that leaving (hese <br />conne�tions means that Ihe risk of 11aoCinc� iroin down �pout or onsde drainage remains. <br />f"pCCC�J11�1J1 f15i(.� �� . <br />Signr�ture 1 r� <br />__J��.� e''�a-Cl`-�.— <br />, <br />, F, . . '. <br />Revised 09109%101-0 <br />ii <br />Dlate <br />5_ <br />Page 2 of 2 <br />