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, - , _.. . <br /> ,, . . .. . . . . . ._ . . •.L�•�-�`� . . <br /> . , BACKWATER PREVENTION DE�YICE PROGRAM <br /> Our records indicate that a backtvater prevention device must be installed on your <br /> sewer conneclion to comply wdh Ihe new ordinance Please help us verify thal our <br /> informalion is correct by answering the following queslions about your property. <br /> Do you have a basemenl?'Yes � No ❑ <br /> If yes, does it have plumbing Gxtures (sink,toiiet,lloor drain, etc.)? Yes� No ❑ <br /> Do you have a backwater valve on your se�eer line? Yes ❑ No ❑ Don't Know � <br /> Do you have a grinder pump in your basement? Yes ❑ No � Don'1 Know ❑ <br /> '�;' .. <br /> Name. �j ,�-f" �/�.rt��'1'J��� A J✓S o �� <br /> Property address: �.3.�_c3�_(l_� G_t�1�t I- ✓e H C't�'/ w�� � <br /> ---'_ `i f��-�r <br /> Phone 1: ad_��I �� U�_�_�p_ Phone 2 ���l�p� <br /> . [mail: �� �1.�i L'.n� /.� C� n� $��. Gvin_. — _ .�'.� <br /> y--- ---T -- <br /> �:�,�:��,�U1i�������.������i�►r�i:r,i:�;��:"�: t:� E <br /> . - _' � <br /> . . <br /> _ _-- -• -- --= - ...�,. _ _--- - - <br />