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--i . — ._ . _ <br /> :�,,.. <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records ir�dicalc ihat a backr�ater pievenUon dewce must be installed on ycur <br /> see:er conneclion to comply with the netiv ordinance Please help us venfy that our <br /> �nformation is correct by anstivenng thc follo�ti�ing questions about your property <br /> Do you have a 6asement� Yes �J No ❑ <br /> If yes; does it tiave plumbmg fixWres (sink, �oilet, `loor dra�n, etc )? Yes �No ❑ <br /> Uo you have a backwater valve nn your sewer line? Yes ❑ No ❑ Donl Know/?� <br /> Uo you have a grmder pump in your basemenl7 Yes ❑ No �on'l Know ❑ <br /> Name. �,(`�.`�'? —��. -���5---- I <br /> Property address..�_C�1 ���'_�( !�� ' • <br /> !,� / <br /> Phone 1: __���'ri�_ Phone 2 -- <br /> Email: �.l�j(1✓���_S - C�U �•' SS @ ��I.�Q�.. LO k1 <br /> �--- - -- — -- -- — I ��+ �1�f ',��15J i':,R,`1`,1' li.;'�4�:��,�'���� : �' , 1 <br /> � . ._ r --- � tlr���l�c�U�1.�J.illlit':s1:�it�' '�Y�u�:'LL1:::+..t�"`:[L'1'?.�,r,-,T� ■ <br />