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� i � <br /> Backwater Prevention Device � <br /> � Proper#y Owner Rebate Form <br /> Please verify the fol�owfng ftcros: <br /> �am the owner of the property served by the side sewer where the Backwater <br /> Prevention Device was installed. <br /> �worked with my contractor to determine the installatior lacation for the Backwater <br /> � PFevention Device. I understand that the final decision regarding installation location <br /> was mine. <br /> If the Backwater Provention Device was installed on my property: <br /> � • �I have been shown how to accoss, inspect, and maintai� my device by my <br /> contractor <br /> • I understand the City will not maintain the Backwatar Prevention Device. I <br /> am exclusively responsible to maintain il and to kee�. 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 malntain it. <br /> Choose one of tho following: <br /> �As of now, my property has no downspouts or other onsite dreinage that connects to <br /> the side sewer upstream of lhe installed Backwater Preventfon Device. <br /> or <br /> ❑ 1 still have downspouts or other onsite drainago thal connects to the side sewer <br /> upstream of tha installed Backwater Prevention Device. I understand ihat leaving fhese <br /> connections means that the risk of flooding from downspout or onsite drainage remains. <br /> I accept that risk. <br /> Signature � Date_ ��" 5' � �7 <br /> Page 2 of 2 <br /> Revised 09109l2014 <br />