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i <br /> i _ . . <br /> � <br /> ���������v�� <br /> j OCT 3 0 2013 <br /> � BACKWATF.R VALVE AUTIIORIZATIONpUBLIC WOIZKS <br /> � I. Permission �o Insnect. Thc Owncr grants permissiou to tlic Cit} and its contraclor to <br /> inspecl Ihc plumbing and dninagc of t6e riwncr's prnperty for Ihc purpnsc oF gatl�cring <br /> ' inforination rcgarding whcthcr n backwa�er ��alvc should bc insiallcd. "1'lic City and <br /> Owncr will caoper.tle lo dclennine� y�;rtually agicc hle tin)�e for e insp�� I�hc <br /> E inspcclion is at thc Ciq�'s solc cosC�✓ [�j� ���IL'.G� <br /> � <br /> � 2. I3ackwalcr Valvc. <br /> r\. CiIV Rcvicw nf Ins�ction nnd Pcrmission to.(nstall Rack�vatcr Val��c. Thc City <br /> will rcvie�v Ihe results of the inspeclion and n�ill detennine wheiher a b��cl:�cater <br /> valvc shoidd be inslalicd. I3y signing this au�horization, thc Owncr granls thc <br /> ' Cily and i�s contractor permission �o inslnll thc back�vaicr valvc if Ihc City i <br /> dc��nnincs Q�ai a bacl:walcr valvc shuidd bc insmllcd. 'I'his ins�allation is nt Ih� i <br /> � City's solc cas�. <br /> , 1;, Olhcr bcviccs. Thcrc may hc nlhcr dcviccs dmt providc as good as (or greatcr) � <br /> protcction Ihan a I18CIC�\'Alq' \'�IYC. I3y signing Ihis nulhorizalion, �hc Owncr i <br /> grants the City and its contraclor permission to inslall thc olhcr dcvicc if thc City <br /> dcicrmincs lhal it should bc inslallcd. l�his inslallation is at Ihe City's solc cosl. ' <br /> Howcvcr, If IIIC OlVI1Cl' (ICSIfCS If1Sl�II01100 OI lI1C OfI1Cf ACVILC� hut ihc City has I <br /> � dcicrmincd to only install a back�vatcr valvc, lhcn lhc O•.vncr may install Ihc uthcr <br /> � deeice, and the Cily will ciinhursc ihe Ownc up to Ihc inslall��iian cosl of�hc <br /> 1 backwatcr valvc.�•��'�`'���/�0 !/ . <br /> � C. �uiurc M:+inicnancc. Upon ins�all�LLiun, Ihc bndcwater �alvc ur od�cr Jcvicc is llic <br /> ; O�vncr's propci ty. Thc Owncr is cxclu�eely responsible t�n�l3�e,j,nq i��� <br /> ,', 3. Ullicr Rccqninicndcd hnprovcnicnls. A(icr itu complction of t ic inspy C�On, �hc C' y <br /> may providc lhe Onner�aidi u list of olher recomnunded im�irovements C lhc propeily's <br /> �: plwnbing and drain��gc sys�cros. 'fhc n�vncr is respnnsiblc fm dcicrmim�ig whclh r lo <br /> ? implemcnl lhc reconunenciations on ihe Iisi tmd for paying lor Ihe iirplcmcntatio�r�� � <br /> ' V1'NGR: �GQC� D. /� <br /> � <br /> ; ��u����si_i�J_ - - ---- - � <br /> Si � aturc: Signauuc: <br /> I <br /> ; U(�1-f1- ��e_�L���tJ -- <br /> � Print• 'amc: Printcd Nmnc: <br /> 1{ /�X - _ ��/l._C�Yl_J�L.I�(�'/ ' <br /> i - <br /> � ��«�� � d,� 5 �� Av�� ����� 9� I <br /> , <br /> , _ <br /> , <br /> , �z. <br /> � ,� <br />