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� <br />Backwater Prevention Device <br />Property Owner Rebate Form <br />Please verify the following items: <br />� I�am lhe owner of the property served by the side sewer �vhere the Backwater <br />revention Device was installed. <br />(� I ivorked with my contractor to determine the installation location for the Backwater <br />Prevention Cevice. I understand that the final decision regarding instalfation location <br />was mine. <br />f� If the Backwater Prevention Devir.e was installed on my property: <br />• I have been shown how to access, inspect, and maintain my device by my <br />contracfor <br />• I understand the City �vill not maintain the Backtivater Prevention Device. I <br />am exciusively responsible to maintain it 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 Device and the need to maintain it. <br />Choose one of the following: <br />[� As of now, rny property has no downspouts or otner onsite drainage that connects to <br />the side sewer upstream of ihe installed (3ackwater Prevention Devic.e. <br />or <br />❑ I siill have downspouts or other onsite drainage tha! connects to the side sewer <br />upstream of the installed Back�eater Prevention Device. I understand that leaving these <br />conneclions mea�s that the risk of flooding from downspout or onsite drainage remains. <br />I ar,cepf that risk. <br />,.. <br />�� �� <br />G _ <br />Signat�e_ ��C �-�l�iiT %����ate �Y � �' % � <br />I <br />P�ge2o(2 <br />Revised Og/09.�207d <br />