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i T�Ct <br />I � � <br />■•• . <br />� <br />KWATER PREVENTION DEVICE PROGRAM <br />:f'• <br />Our reco�ds indicale that a backwate� prevenhon device must be installed on your <br />sewer connedion to comply wilh ihe nev+ ordinance. Please help us venfy ihal our <br />information is correct by ansvrenng the followmg queslions about your property: <br />Do you have a 6asement? Yes [✓J No ❑ <br />If yes, does it have plumbing fixtures (sink, toilet, floor drain, etc )? Yes � No ❑ <br />Do you have a 6ackv�ater valve on your sewe[line7 Yes [� No ❑ Don't Know � <br />Do you have�gnnder pump in your basemenl? Yes ❑ No ❑ Don't Knotiv ((� <br />Name: <br />'y r <br />Property address � 1 13 � P—��j�_ <br />I �1 ✓ <br />Phone 1�/ �`�'�� �� a' � 1 V Phone 2' <br />Email: <br />z��'it�,� �.t�.s <br />,..�., . <br />1.�.;�::::31:LLiin <br />