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, C-��: <br /> .,:�� <br /> BACKWATER PREVENTION� �JEVICE PROGRAM <br /> Our recerds indicate that a back�va,er prevention device must be installed on your <br /> sewer conneclion to comply wilh the new ordinance. Please help us venfy ihat our <br /> informatron is correcl by anserering the follo�wing questions aboul your property: <br /> Do you have a basement? Yes i�No � <br /> If yes does i1 have plumbing fixtures (sink, toilet, oor drain etc.)7 Yes�No ❑ <br /> Do you have a backwater valve on your seaer line� Yes ❑ No ❑ Don't Knov✓ � <br /> Do you have a grinder pump in your basemenl? Yes,❑ No �'Don't Kro�v ,-' <br /> Name: \_K ��C / � � •1'��. -- -- — <br /> Property address _� -�`� �� � ��""�'���'�-- <br /> Phone 1: /�r���_���L-Phone 2 --_ --- <br /> F�,,,�� c.r/C����i;_n�v�_A_r ;_r.: . � fi� <br /> -�-�-. �_-� <br /> - -• _ r_--- -,�:�1,+�����1 j �l ��t• ,,3�,,�,�����,i � I��,,�� ,,�(, . ' , <br /> .i ui t .r.lswi4r'�ltC1lL_''}L';�i1,.in`?�li��.�., Ed_ . <br />