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I <br /> I <br /> 1 • � � <br /> i Backwater Preve�ntion Device <br /> � Property Owner Rebate Form <br /> i <br /> Please verify the foilowing items: <br /> �,I am the owner Iof the property served by the side sewer where the Backwater - <br /> Prf:venlion Device was inslalled. <br /> �I worked vdith m;y contractor to determine the inslalllation location for the Backwater <br /> revention Device.jl under3tand tiiat tfie final decisiol regarding installation location <br /> tv:,s mine. <br /> i � <br /> � If the Dackwateii Preventic,n Device �vas installed on my property: <br /> • I havo been shov,m how to access, inspect, and maintain my device by my <br /> contr�ctor I <br /> • I understand the City will nol maintain t�'e Backwater Prevention Device. I <br /> am ex'clusively responsible to maintain if and to keep it in good working <br /> order.� <br /> • If I sell my property, I will make the buyer aware of the Backwalcr <br /> Preveiilion Device and the need to maintain it. <br /> Choose one of the�following: � <br /> i <br /> I ; <br /> (�As of now, my pfoperty has no downspoiUs or olher onsite drainage that connecis to <br /> t�ie side sewer upsl�eam oF ihe installed Backwater Prevention Device. <br /> or � � <br /> ' i <br /> ❑ I slill have downspouts or other onsitr. drainage thal connects to the side sewer <br /> upstream of lhe installed Ciackwaler Prevention I]evice. I undersland that leaving fhese <br /> conneclicns means thal the risk of flooding from downl pout or onsite drainage remains. <br /> I accept that risk. � <br /> i i <br /> Si,qnature_� <br /> -�---�— _ D:�te� � . � � — <br /> I ,1�� <br /> � I <br /> � � <br /> I ' <br /> � �. <br /> � � <br /> i <br /> ' j Pac�e 2 nl2 <br /> Revised 091091201q i i <br />