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I3ACKWATER VALVF. I11'STALLATION PRUGRAM <br /> INSTALLATION AUTHORI'/.ATION FORM <br /> L Pcnnissiou to Tnsncct. Tlic O��aicr granis permission to thc City mid iLc cuntractor to <br /> inspect the plumbing and drainage of the O���ner's properly for �he purpose of <br /> determinin� whcthcr a backwater ��alve SII011I(I IlC Ifl$I:IIIC(J. I�III' City mid O���ner will <br /> couperate to Jclemiine a mutually ;igrecablc time for the inspection. The inspection is at <br /> tlic Cih�'s sole cost. <br /> 2. 13ac��qater Val��c Install:Uion. 'I�hc City �sill rc��iew tl�e results of Aie inspection aiid will <br /> determine ���hether a bac6���ater ��alve should he installed. l;y signing this authoriration, <br /> the O�«�er grams thc Cit}� :uid its contractor permission to u�stall the back���atcr ��alve if <br /> thc Cit}' dctcrmines that a backwatcr ealvc should hc installcd. 9'his installalion is at thc <br /> CII}�'S SOIC COSS. <br /> .i. Site Drainaec. li inspection ot�tlic property identitics that there are do«nspouts connected <br /> to thc side scn•cr ups4'cam of Ihe proposed backwa�er �al��e location the do��nspouts �vill <br /> be disconnectcd or rc-routcd downslrcam of� the back�aater valvc. 13y signing lhis <br /> audiori�ation. the O�vner grants thc Cit} ;md its contractor pemiission to xcess the <br /> O�wiei's property to �iodify drainagc conncctions. llrainagc modifcation is at thc City's <br /> solc cost. <br /> OWNI;R(ti): <br /> .Slaa... /"� "'""' .^rxL``___--.. <br /> Signulurc: Signaturc: <br /> nan2vie.i Z�GNsLZ�7 W�R <br /> Prinlcd Namc: Printcd Namc: <br /> ( FT �"' ll W�l <br /> Prin �d Address �?$1 <br /> `{25- 2�-i'-t - HZ�-iFi <br /> Phonc'Numbcr <br />