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� <br /> . J <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate �hat � back�•,.;Pr prevenUon device must he mslalled on your <br /> se�ver connection to comply with �he new ordinance Please help us verify ihat our <br /> information is corred 6y answering the followmg queshons about your property. <br /> Do you have a basement� Yes �No '] <br /> I(yes, does it have plumbing fixtures (s.nk, toilet, floor drain, elc )? Ves� No �,� <br /> Do you have a backwater vaive on your sewer hne7 Yes ❑ No �� Uon't Know ❑ <br /> Do you have a grinder pump in your basement� Yes ❑ No � Don't Know [� <br /> Name �--���. .UGW[� <br /> /J /-/� - - - --/-j---- - <br /> Property address _i,;��S.6�4/ `� ' J v�----- - -- — <br /> Phone 1: y���� S� Phanc 2 ��(Y' /�(T //CF'� <br /> Finail� �,�/y;juQ iv�'�i�• l 4J1� <br /> _ ____ ._.--__. ___.__ —____—_— ; <br /> __._r-.�. , _"�_—. . . . . � <br />