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i <br /> `s <br /> 0 Backwater Prevention Device <br /> Property owner Rebate Form <br /> Please verify the following items: <br /> ff am the owner of the property served by the side sewer where the Backwater <br /> Prevention Device was installed. <br /> ®'I worked with my contractor to determine the installation location for the Backwater <br /> Prevention Device. I understand that the final decision regarding installation location <br /> was mine. <br /> ff'lf the Backwater Prevention Device was installed on my property: <br /> • 1 have been shown how to access, inspect, and maintain my device by my <br /> contractor <br /> • 1 understand the City will not maintain the Backwater Prevention Device. I <br /> am exclusively responsible to maintain it and to keep it in good working <br /> order. <br /> • If 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 /> [9'/As 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 Backwater Prevention Device. I understand that leaving these <br /> connections means that the risk of flooding from downspout or onsite drainage remains. <br /> I accept that risk. I <br /> 2 <br /> Signature Date <br /> �i <br /> aa <br /> 1 <br /> Page 2 of 2 <br /> : <br /> : <br /> : <br /> Revised 09/09/2014 <br /> f <br />