Laserfiche WebLink
i <br /> "IIPI,"'.- Backwater Prevention Device <br /> 127, i Property Owner Rebate Form i <br /> i <br /> 1 <br /> Please verify the following items: I <br /> I <br /> Xam the owner of the property sewed by the side sewer where the Backwater <br /> Prevention Device was installed. <br /> :i I worked with my contractor to determine the installation location for the Backwater <br /> 15 evention Device. I understand that the final decision regarding installation location <br /> was mine. <br /> ! If the Backwater Prevention 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 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 /> dli 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 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 P <br /> connections means that the risk of flooding from downspout or onsite drainage remains. <br /> I accept that risk, <br /> 1 <br /> Signature .SGL 3 ) iffl Date / 'C'" ✓ 117 <br /> i <br /> 1 <br /> I <br /> 1 <br /> 1 <br /> Page 2 of 2 <br /> 1 <br /> i <br /> Revised 09/09/2014 <br /> 1 <br />