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i <br /> Backwat�r Preve�tion Device _ <br /> Ev Prop�rty Owner Rebate Form <br /> � <br /> Please verify the foilowiny items: ; <br /> t��I ni fhe owner of the property served by the side sewer�vhere the Bdr,kwater <br /> Pre•�ention Device was installed. - <br /> i <br /> �t , vdorked wilh my contractor to determine the installation location for ihe Backa�ater <br /> P�evention D�vice. I understand that the final decision regarding installation location <br /> w��s mine. <br /> L• f the Back�vater Prevention Device was installed on my property: <br /> • I have been shov,�n hov� to access, insp�ct, and maintain my device by my <br /> contractor <br /> • I understand ttie City�vili not maintain tfie Backwater Prevention Device. I <br /> am exclusively responsible to maint2in ii and to keep it in good working <br /> order. <br /> • If I sell my properiy, I will make ttie buyeir avdare of the Backwater <br /> Prevention Device and the need to mainiain it. <br /> Cfioose one of the following: <br /> � � :As of novd, my property has no downspouts or other onsite drainage that connects to <br /> the side sewer upstream o(the installed Backvdater P ievention Device. <br /> or � <br /> ❑ I still have downspouts or other onsite drainage ihat connects to the side sewer <br /> upstream of the installed Backwater Pre��antion Device. I understand thai leaving ihese <br /> connections means that the risk of flooding from dovdnspout or onsite drainage remains. <br /> I accept that risk. <br /> � <br /> 1 i <br /> Signature ���,.,.�,�1'�� ��I_j SDate �- � �� 1 .� <br /> ( I <br /> I <br /> i <br /> � <br /> � <br /> � Page 2 of 2 <br /> i <br /> i Revised D9/091201h <br /> I � <br />