HomeMy WebLinkAboutAdopt A Drain Program Application 2018CITY 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 your yard waste container.
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. Letters and/or emails will be sent to residents annually in March inquiring
whether they would like to renew their agreement for another year.
In exchange for a yearly $24.00 credit on my City utility bill, 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: