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a <br /> .. . _ . -:.1— � ---- _ <br /> �', ,, <br /> - .� :.ti:,. . <br /> BACKWP;TER PREVENTION DEVICE PROGRAM <br /> O�u records indicale that a bar,kc�ater pr�vent�on device must be installed on your <br /> sa�;er cor.neclion to comply wiRi ihe nev,� ordinance Please help us veri(y ihat our <br /> �nformation is r,orreci by �nswering the following questions about your property <br /> Do you have a basement? Yes t[�No ❑ <br /> If yes, does it have p�umbing fztures (sink, toilet, floor drain, etc.)? Yes �No � <br /> po you have a backv�ater valve on your sev�er line� Yes ❑ No ❑ Don't Know I J <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don-t Knov+ [�Y'" <br /> �o�.,, i n; co Ca �t�i'rre�-G . <br /> Name --- -- ---- <br /> 9 � � �� . <br /> Propery address. _ ��� � _ �� � � � _— <br /> Phone t T.i'S ��SZ�'S�'�� Phone 2 _ <br /> - -i r,� i� r����n�t;v��--��rc� (� �rc� l�oo . ���n _ � <br /> �=�„� � --- _ <br /> .:...-- -- - — ; _ '` '����'C`�t1 , � �I 1 : } l�c7^ � <br /> � ��:1��•ma.d:a�,,,�.,ll�,�.�; � ;�.r�_��i ��11 ��:�, _ �.z�:t:�.�� k4�: <br /> I <br /> I <br />