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� <br /> BACKWATER PREVENTION,DE�IICE PROGRAM <br /> Our records indicate lhat a back�ater prevention device must be inslalled on your <br /> sewer connection to comply v�ith Ihe new ardinance Please heip us verify thal our <br /> information is correct by answeri�y lhe follo�viny questions aboul your property: <br /> Do you have a basement? Yes�No ❑ <br /> i <br /> If yes, does il have plumbing fixWres (sink, toilet,floor drain, etc.)7 Yes� No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know� <br /> Do you have a orinder pump in your basement7 Yes � No ❑ Don't Know �,; <br /> Name: G�� � NV�0.5-�'Y1 <br /> Property address: �•� C2. �+�1,._1�A—� <br /> V <br /> Phone t: `�"L5-�-S 2.'�L�'� Phone 2: . �'LS.- ��y "�Lfy� <br /> [mail: __����"t�^�r�? L��R�17 . �/YYI�'� <br /> �,�ill�, �'tI�������j],•ay(ull;.Y�" 1 <br /> . -- t___ .' 't .1:�i�`yi,il��'�...SI;��:.���.ii.' i11L'1Ltl.�'1ti. '��.t.'.i�.d1l��.L!' r:,� 0� <br /> ' ,�.: <br /> .��� . <br />