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� <br /> � <br /> � � Backwater Prevention Device � <br /> ' a Property Owner Rebate Form i <br /> � <br /> � � <br /> i ; <br /> Please yerify the following items: ' <br /> �I �m the o�vner of tfie property served by the side se�ver v:here ihe Backwater <br /> revention Device was installed. <br /> f�l Y�orked with my contractor to determine the installation location for the Backwater � <br /> Prevention Device. I understand thal the final decision regarding installatio� location ' <br /> �vas mine, <br /> i <br /> i <br /> � If,the Backwater Prevent�on Device was installed 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��dater Prevention Device. I � <br /> am exclusively responsible to maintain it and to keep it in good working i <br /> order. <br /> • li I sell my property, I �vill make Ihe buyer aware of the Backwater � <br /> Prevention Oevice and the need to maintain it. � <br /> I <br /> Choose one of the Eollo�ving: � <br /> As ot now, my property has no downspouts or other onsite drainage thai connects to <br /> he side sewer upstream of the inslalled Backwater Prevention Device. <br /> or <br /> ❑ I still have do�:�nspouts or other unsite drainage that connecis to ihe side sewer <br /> upstre2m of the irstai!ed Back�vater Prevention Device. I understand that leaving these <br /> connections meens thai ihe risk of flooding from downspout or onsite drainage remains. ! <br /> I accept that risk � <br /> , /� , <br /> / �., / � <br /> Signature_��__ ��,� Date _ J/ L S %S � <br /> � <br /> / i <br /> I <br /> I ' <br /> � <br /> i <br /> Page 2 of 2 � <br /> I <br /> Revised 09i09/7014 <br />