CITY OF CLARKSON VALLEY
PROPERTY OWNER RELEASE FORM

I/We, ___________________________________________________________________ the property owner(s) of _________________________________________, Clarkson Valley, Missouri hereby authorize the City of Clarkson Valley and approved plumbing contractors to enter onto my property in order to repair my sanitary sewer lateral. As part of this work, I realize that there will be noise, dirt, dust, mud and inconvenience. In the process a large hole will be excavated and earth mounded in my yard. My property could become damaged by the use of large machinery and stockpiling of materials.

I agree to hold the City and the approved contractor harmless from minor damages that could result from this work. In turn, I expect the contractor to provide the City with a Certificate of Insurance and Performance Bond to guarantee the completion of the necessary work.

I understand that the City's sanitary Sewer Lateral Repair Program does not cover the following items that will be the property owner's responsibility:

1. Repairs to sewer lines inside the house, under the basement floor or in crawl areas under decks or any part of the house structure.
2. The City's maximum payment is $5,000 total for the cost of the project.
3. To restore any landscaped areas, sprinkler systems, private driveways, fences, walkways, retaining walls and other structures that may be damaged within the normal work limits.
4. Sanitary sewer line repairs under any permanent or semi-permanent structures such as garages, sheds, swimming pools, porches, steps, playgrounds, retaining walls, etc., unless these items are removed first by the property owner or unless the owner pays all additional charges to relocate the sanitary sewer line around these structures.

Signed ___________________________________

       ____________________________________

Date   ____________________________________

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