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. . � .- . dJ .. <br />_ :..�;.,�--.. <br />.',���BACKWATER PREVENTIO�DEVICE PROGRAM <br />. _ . �� <br />� Our records indiwle that a backwater prevention device musl be installed on your <br />sewer connedion lo comply ���ith the new orC;��ance. Please help us verify Ihat our <br />information is correcl by ansvdering the following questions aboul your property: <br />Do you have a 6asement? Yes � No ❑ <br />If yes, does it have plumbing tixtures (sink, toilet, floor drain, elc.)? Yes � No ❑ <br />Do you have a 6ackwater 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 />Name: ��F� r �"c � � � � �-� <br />Property address � 3 L� u I b � J< <br />Phone 1: '�{�y ' Z� � 3 r� 7 Phone 2� Lr7 � Z�l' 3- Z�'l ti' <br />Email: �i_l�L�_ � i %�D �' �V /`'l <br />_ .�.»�_—•-•-•-- <br />_ __ � •_-__.__...___ _ __ - - - <br />