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. ✓ <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indiwte lhat a backwater p�cvenGon device must be installed on ihe sr�we.r <br /> connecl�on at the address identilied oi� the enclosed letter Please help us verify that our <br /> mformation is cnrrect by answering the followmg quesuons about ;our property. <br /> �o you havc a basemenl� Yes � No J <br /> Ii yes, does d have plumbing liz�ures (sink, toilet floor drain, elcJ� Yes ,�No ❑ <br /> Do you have a backwater valve on your sewer line� Yes �,] 'Jo � Don'1 Know � <br /> Do you have a gnnder pump m your basemenl� Yes ] No i] Don'� Knnw i� <br /> Name _�p/�lf�•-.- ✓�o�-��Q�L� A,f_��g- - �� AGr,Y)G/ir4a� <br /> � '- / J <br /> �'���r.rtyaAdress �(p A'��- _l.�.11tr___rJ1I�. �-l�S�� (.V/`f <br /> f'han�? 1 ldt�� ��o�..� . Phone 2 _ �[�? ' 5;7�— .J��� <br /> Ema�l �e � 4yT"��!_7.�'��! 0 _ '�,.. <br /> , , , �---,' -- � � rT�, ---- , � <br /> ir- <br /> .. ��4.�.�_.�'�lL!�_� `'_>iS . _ _.._... _ _. �_... . . . ... .. . . . .' " " .. . <br />