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1!!ei5/:��15 i12:0iPM 4?5353FG07 MAFi_E GROVE RV <br />I1iO4/2015 7;SY P!! YAx d25JJG�;170 CuoDDcll's Pltmbints, Iqc PA�� �5/US <br />I m 0008i0008 <br />Please <br />arn the <br />Backwater Prevention Device <br />Property p�yner Rebate Form <br />the tpl�c�ying items: <br />of tho prOperty sorvetl by th� S;�y SeWef �„hero the Qa�kyydtor <br />�vas instelied. <br />f!G � v+crked �vith my controctor to deterrnine the instellaiion location for the Backwater <br />Preven5on D�vica. I understand thet the frnai dncislon reQardmg installation location <br />tit-as m(n <br />� I( the BaCl�wate� Preventior DFvice wA� installed on my pro ,y ; <br />• � have becn shown how to access, Inspect, and mantnin my dev�ce py rn , <br />contractor y <br />• I unders;ar,a the City wfll not maintain lho Bockvrater Prevnntion Devico, � <br />am exdusively responsible to rttaintein it ar,d to ke�p It in good workl�p <br />order. <br />• f I sell my propprty, 1 wili mako the buyer avrare of the Backwater <br />Ptevertion Devlce and thc, nsetl to m�intsin it. <br />Chooac one If thc followlnA: <br />I <br />s ot now, Imy proqerty, has no downspcuts or other onsite draint]ge (hat conneCts to <br />the sidQ sewe� upsUQam oi the Instaileri BoCkwater Prevention Oovice. <br />or � <br />❑ ! stlll have <br />ups«Bam Of ,I <br />mnnections n <br />�acceptthatr <br />Revised 09;OPI2014 <br />spou[s or other onsite drainage tryn� �onnecta to the sitle sawer <br />elied 8ackweter Prevention Device, I unde�ctand tliai iesving thesQ <br />that the risk oF floodirtg trom downepout or onsito druinage remains. <br />�'—" Date _ //— �^-- "��— � <br />Vege 2 0} p <br />