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,f,. .. . . .. . : �- ;". T _" . _. . .__ _`.- - _ <br /> ` , -l : .�<j�.',1 <br /> -;�i: <br /> BACKWATER PREVEN'fION DEVICE PROGRAM <br /> Our records indicate Ihat a backwaler prevention device must be inslalled on your <br /> sewer connec�ion to comply wilh Ihe new ordinance. Please help us venfy lhat our <br /> information is co�•ecl by answering ihe following queslions about your property: <br /> Do you havc a 6asemenl? Yes p� No ❑ � <br /> / � <br /> I(yes, does il have plumbing fixtures(sink, toilet, Iloo�, elc.)? Yes�� No � I <br /> Do you have a backwater valve on your sewer line? Yes [) No ❑ Don't Know� <br /> Do you have a grinder pump in your basement? Yes ❑ No � Don't Know� <br /> r .-{�� <br /> Name: 1 - �V1��1-i_!--. <br /> Property address: �.. 'O� 1_O f �� �L�-�_ <br /> Phone t: Phone 2: <br /> [mail: _—<� rri_ ( I—�� yJ����-�/�_C�� <br /> `i ' .;x^ '—r_'� <br /> ,:. . � . . '.i �i <br /> . .. . .. . . . . . <br /> ; �.r��t _-_ . ..i> ._ �., ;i� �: _..:; .. . ' , _ . ._ �. .,: _ . � � .. , - ., , <br />