HomeMy WebLinkAboutAAI Application 2016.pdfCITY OF IOWA CITY ADOPT-AN-INTAKE PROGRAM
STORM SEWER MAINTENANCE AGREEMENT
*PLEASE BE ADVISED* Various drains throughout the City have already been adopted. To check the availability of the drain you
would like to adopt, you may contact the Streets Division at 356-5181.
Name:_________________________________________________________________
Address: ____________________________________________________________________
Home Phone: _______________________ Daytime Phone: ____________________________ Does the proposed intake have a metal grate?___________ Do you clear it now?___________
Does the proposed intake have a history of blocking with debris? ________________________
_____________________________________________________________________________________ Location of the intake in relation to your property: (Please include a detailed sketch)
Guidelines, Safety Tips, Terms and Liability Waiver:
1. Never attempt to clear debris from an intake or culvert if there is moving water greater than knee deep. 2. Always check for traffic before entering a roadway. 3. Separate out any debris that is not yard waste, such as pop cans, cardboard, etc., and put it in your regular garbage. 4. Place the debris removed from the intake in the container on which you have attached the yard waste sticker. 5. The applicant releases the City of Iowa City from any claim for damage to persons or property resulting from the
removal of debris or cleaning of the adopted intake. 6. The city may terminate the agreement hereunder at any time. 7. This agreement will need to be renewed each year when the yard waste sticker expires on March 31st. In exchange for free disposal of one container of yard waste each week, I agree to regularly remove the
debris from my intake in accordance with the guidelines, safety tips, terms, and liability waiver listed above. Applicant signature: _______________________________ _ Date: _________________ PLEASE MAIL COMPLETED APPLICATION TO: STREETS DIVISION, ATTN: ADOPT-A-DRAIN, 3800 NAPOLEON LN, IOWA CITY, IA 52240. PHONE: 356-5181. OFFICE USE ONLY:
Approved by: ____________________________________ _ Date: _______________ __
Dates of agreement: __________________ to __________________ Agreement is a renewal: Permit Number: _________________________ Has received yard waste sticker:___