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Backwa�er Prevention Device <br /> � Property Owner RFbate Form <br /> Pleas verify the following items: <br /> - I am the owner of the property served by the side sewer where the Backwater <br /> �Preve tion Device was installed. <br /> � I worked �vith my contractor to determine ihe instaliation location for the Backvrater <br /> Prevention Device. I understand that lhe final dscision regarding installalion location <br /> was mine. <br /> If the Backweter Prevention Device was im'alleu on my property: <br /> • I have been shown how to access, inspect, and maintain my device by my <br /> contractor <br /> • I understand the City will not maintain the Back�vater Prevention Device. I <br /> am exclusively responsible to maintain it and to keep it in good working <br /> order. <br /> • !f I sell my property, I will make the buyer aware of the Backwater <br /> Prevention Device and the need to maintain it. <br /> Choose one of the following: <br /> � of now, my property has no downspouts or other onsite drainage that connects to <br /> the side sewer upstream of the installed Backwater Prevention Device. <br /> or <br /> ❑ I still have downspouts or other onsite drainage that connects to the side sewer <br /> upstream of the installed Backt��ater Prevention Device. I understand that leaving these <br /> connections means that lhe risk of(loodiny from downspout or onsite drafnage remains. <br /> I accept that risk. <br /> � � <br /> � ; <br /> Signature__ �. � `=) r`1_L� Date ll'%' I / <br /> � y /� ---- <br /> Page 2 of 2 <br /> Revised 09109/2014 <br />