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—, � - , ,;. <br /> �:, <br /> , , . . :,,;. <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicale Ihet a backwater prevention device must be installed on your <br /> sewer connection to comply with the new ordinance. Please help us verify that our <br /> information is correcl by answering the following queslions about your propeAy: <br /> Do you have a basement? Yes �No r� <br /> If yes,does il have plumbinr fizlures (sink, loilet, floor drain, etc.)? Yes �Q No r I <br /> Do you have a backwaler valve on your sewer lire? Yes ❑ No ❑ �on't Know �Q <br /> Do you have a gnnder pump in ynur basement� Yes U No ❑ Don't Know � <br /> Name: _N�C�.. -�A-�--[,1L� --- <br /> Propertyaddress: __53� QI.J(JU5�7`'� �jLVr1 . C.VC��b 9��� <br /> �ho�P t: ZDb $s°) _14 S 6 Pnone z Z06 306 6yS ; <br /> [mail �l��l �c..Q,�1�. ���'1�t1. � ��1 ---- <br /> , , � , � <br /> � .: <br /> . <br /> . <br /> � . , . <br /> • � : . , � , � ,� �. 1 . � . <br /> , . „ <br /> ._ _. ._ . _ . . . . ._ _:� .... . .. . . .. ...._..,.. . . .. .._ ... _ . _ <br /> . ,• . <br />