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i <br /> Backwater Prevention De�•icP I <br /> d -� Property Owner Rebate Form <br /> Please verify the following items: <br /> ❑ I am thc owner of the property served by the side sewer where the Backwater y <br /> Prevention Clevice was installed. <br /> ❑ I worked �vith my contractor to detennine the installation location for the Qackavater � <br /> Prevention Device. I understand that the final decision regarding installation location � <br /> was mine. ! <br /> �l�f the f3ackvdater Prevention Device was installed on my property: 4 <br /> • I have been shown hovd to access, inspect, ar�d main!ain my device by my � <br /> r,ontractor ; <br /> . I understand the City �vill not maintain the Backwater Prevention Device. I � <br /> am exclusively responsible to maintain it anc to keep it in good working ! <br /> order. i i <br /> • If I sell my property, I will mare the buyer aware of the Back��vater <br /> Prevention Device and the need to maint�in it. � , <br /> Choose one cf the following: � <br /> ils of notv, my property has no downspouts or other onsite drainage that connects to � <br /> the side sewer upstream of the installed Back�vater Prevention Device. � <br /> or <br /> ❑ I stil! have downspouts or other onsite drainage that connects to the side sev;er <br /> upstream oi tYie installed Back�vater Prevention Device. I understand that leavin� these <br /> connections means that ihe risk of ilooding from downspout or onsite drainage remains. <br /> I accept that risk. <br /> Siqnature � ,i (����n Date '� d3 �`'r <br /> Page 2 of Z I <br /> Revised 09/09/2014 � <br /> � <br /> � <br />