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� <br />W <br />7' <br />� <br />„ ,�, <br />. ,% � <br />. � d, - , <br />� <br />• =� <br />. ;'y�` <br />� � � ?'t: <br />� . � � . 4jAL. <br />�, <br />BACKWATER PREVENTION DEVICE PRQGRAM <br />Our records indicate that a backwater prevenlion device must be installed on your <br />se�ver conneclion lo comply with the new ordinance. Please help us verify that our <br />information is correct by answering the following questions about your properiy: <br />Do you have a basement7 Yes f-`�No ❑ <br />If yes, does it have plumhing fixtures (sink, loilel, floor drain, etc.)? Yes •�No ❑ <br />Do you have a backwater valve on your sewer line? Yes [ No ❑ Don't Know �Q <br />Do you have a grinder pump in your basemenl? Yes ❑ No ❑ Don't Know� <br />Name: ^_'�S�'���' n) /{�(�,L�>�.J <br />r /j d� <br />PropeAy address: J �Z— l_b�-/ /V� ��7-�Jr <br />Phone 1 � .Z � - Phone 2: ��j 3 � 7 � Z % .3 <br />Finail: _/_Y�U-JVLil��S-�--�� �/� •_�..Q.r!/� <br />