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1 <br />BACKWATER PREVENTION DEVICE PROGRAM <br />Our records mdicale that a back�;�ater prevention device must be installed on your <br />sewer conneclion �o comply wilh ihe ne�v ordinance. Please hetp us veriFy that our <br />intormation is correcl by ansv+er�ng lhe following questions about yo�r property: <br />Uo you have a basement? Yes '� No ❑ <br />I! yes, does d havc plumbing fi�ures (sink, toilel, iloor drain, etc.)? Yes � No j� <br />Do you have a backwater valve on your sewer Iine7 Yes ❑ No � Don't Know ❑ <br />Do you have a gnnder pump iri your basement� Yes Q No � Don't Knov� ❑ <br />Name Si L L <br />Propertyaddress ��ti� CoL�%��t'� E.'(.CXC �(� <br />Phone 1: �L't- 2�� ^I�jy� Phone 2: � ---- <br />Frnail / r- --_-- — <br />■�� i I� � i i�,} i �`J i, l r'• �,�11��� '��'�°4r• :� ` �I <br />i �l(:������I_:iN.iU'il�:'e:!',?.f:-'C�{+i.����jl�i�':�,i..c'`f �'.'Z��F.L.�% <br />p�tv _ . .. .. . <br />