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-- - - -- --- — _ ,/ <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backc:ater prevent�on dev.ce must be mstalled on your <br /> se�ver connection to comply vnlh the ne�a ordmance Please he!p us venfy that ou� <br /> information is correct by ansv�enng the ollowing questions a5out your property <br /> Do you have a basement7 Yes No ❑ <br /> If yes, does it have plumbing fixtures (s�nk, toilet, tloor drain, elc )7 Yes J No ,�]�' <br /> Do you have a backwater val��e on your sewer hne� Yes ❑ No ❑ Don't Kno�� [� <br /> Do you have a grinder pump in your basement? Yes ❑ No �Don't Know �] <br /> ��a,��� l�) �2 c c �� � � <br /> Name -------- <br /> Properry address <br /> �CJ�� ��' F� lV n j� � e ` _ ��r','c,� (t/�� . <br /> Phone 1 �i� S— � 1 y f Z� �� Phone 2 - - - _ _— <br /> [mail �'J����r�`f��0 ��'"4-,�C� . l..-G n'� ' — -- - <br /> . <br /> -- <br /> --- -- <br /> � -� •- ----- .. . _�_...._ _� ��� <br /> �� - _ . . . . <br />