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BACKWATER PREVENTION DEVICE PROGRAM <br />Our records indir,ate that a backv�ater preven;ion device must be installed on your <br />sewer connEction to comply v�ilh the ne�v ordinance Please help us verify lhat our <br />�nformatior: .; correct by ans�:�ering the following questions about your property <br />Uo you have a basem?nl7 Yes�No ❑ <br />If yes, does il have plumbing 5xtures (sink, toilet, floor drain, etc.)� Yes [,�o ❑ <br />Do you have a backwaler valve on your see�er line? Yes ❑ No ❑ Uon't Know [� <br />Do you have a grindei pump in your basement7 Yes ❑ No ❑ Don't Kno�v [,k-- <br />� <br />Name. � U� �G /` G i/ i n�_ <br />Property address d� �� � `� ' '� n � <br />Phone 1! c��J c� —0 I/G+ Phone 2 y�r-3� �-�/!-�� <br />F�„a�r ` /.>� Y'G 1� � .n � G�c�C-ts »--}_— <br />------�J-- � - — _ .--- - <br />.�Y.. _t_.....� . . _ . <br />� _l.. � ._ _ . <br />