Laserfiche WebLink
BACKWATER PREVENTION DEVICE PROGRAM <br />Our record; indicate ihat a back�•�ater prevention device must be installed on your <br />seLver connection to comply v�dh the ne�v ordinance Please help us verify that our <br />in(ormahon is correcl by ans���ering the follovnng questions about your property <br />Do you have a basement? Yes �No j_, <br />If yes, does il ha.e plumbing fixtures (smk, todet, floor drain, e'c j� Yes � No ',J <br />Do you have a backa�ater vaive on your sev+er hne� Yes ❑ No �] Don't Know'�` <br />Do you have a grindcr pump in your basemenl? Yes ;] No ❑ Don't Know ❑ <br />1G ,' ��'�C vl �� <br />Name --- <br />��2 l ����� ��� <br />Property address �/ �yT� n —. - <br />Phone L�✓� -/ ^� ���✓( Phone 2 <br />- �/, � � <br />Finait NL ✓/V _V �_� ( ���^���r1 � ! C���- - <br />..�,La.r�n _.i...-- �,,p;��'�!' .1.... � � 1�i� <br />