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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records mdicate that a back�vater prevention device must be mstalled on your <br /> seiver connedion fo comply tti�ith the ne�v ordinance Please help us verify that our <br /> information is ccrrect by answering the tollo�smg queslions aboul your property <br /> Do you have a basement7 Yes (➢�, No [] <br /> If yes, does it have plumbing fixtures (sink, tollet, floor drain, elc )� Yes � No C <br /> Do you have a backv:ater valve on your se�ver iine? Yes ❑ No (k� Don't Know ❑ <br /> Do you havc a grinder pump in your basement7 Ye� [' No � Don't Kno�v J' <br /> • Name ��CSS /�55-e�►"(�q'r� <br /> - - - -- -- <br /> Property address ��J���V'� ___ <br /> 1'hone 1.'l�� � O � / $� Phone 2 <br /> f_�„o�i �t r� r�u<K ���i�fal11,aa � C.� -- --- <br /> i <br /> �i r , �•��•• <br /> 7� � ' ' , � � p��1���1�. <br /> �11 - - — - - -- ;:Q,�,��: .I��r I���,��,;��,��i4';1!'�`�}��,!;��. ::,,•�:��:L�!:•� ci� <br />