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rti <br /> .h <br /> i . . ,, <br /> BACKWATER PREVENTION DEVICE PROGRAM / <br /> Our records mdicale ihat a backwater prevention device musl be instalied on your <br /> se���er connection to comply v✓ith the new ordinance Please help us venfy that eur <br /> information is correct by answering the (ollowing questions about your property: <br /> Do you have a basemenl? Yes`�J No ❑ <br /> If yes, does it have plumbing fixt�res (sink, loiiet, floor drain, eta)? Ye-.�(J No ❑ <br /> /� <br /> Do you have a backwater valve on your sewer Iine7 Yes ❑ No Don't Know [ <br /> �o you have a grinder pump in your basemenl7 Yes �] No � Don't Kno�v ❑ <br /> Name: d/�`""'t f` � S �/e /`" ' ` V1'dY� <br /> Property address� !O ` � �r�� �� �— <br /> Phone 1: �Z5 Z S Z �S� � Phone 2: <br /> Emad: / vL� �`vl6✓�S� �° Coln� �0.�'J , ►�2� <br /> , �:' . �f�'kl���lf,� �f:kK� y'� I'� ' � <br /> � � <br /> - - -- � -r- �l���a�rJ��s�,�.�.:;.�;�1Jjn«<lJf�lal,l,�;r.��:�:':�.L+_�rs.l <br />