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- -, � � <br /> BACKWATER PREVENTION DEVICE PROGRAM i <br /> O�.�r rr,cords �ndicate Ihat a bac'r.��aler.p:evcnhon device must b� �nstalled on the serrer <br /> connecl�on al the address idenhfieel on the enclosed letter Please h�lp us v2nty Iha; our <br /> m�ormation is correct t�7 ans::�ering lhe follof����g queslions about your property <br /> Do you have a basement� Yes !�! Nu �_ <br /> 7'� �/ <br /> If yes, does it have plumbing fixtures (sink, todet, floor drain, etc )� Yes �)( No [ <br /> T� <br /> � <br /> f)o you havz a backv:ater valve on y�ur se�:�er line7 Yes ❑ No Don't Knoe: , � <br /> !)o you have a grinder pump in y6ur basemenl� Yes ;� No �Don't Know � ! I <br /> r���,� _��f N_G1�Iv l_-_���� C�I � _ <br /> I�roperty ,ridress _/ 5 � / � . -_ .._ — <br /> �hone�l� 02�.�_y � C1 S Plione y, <br /> ���-5�g�� <br /> � �,.,�� - - -- -- ' <br /> ,, <br /> ! � ,II ' � i i � ' i�i��,����4�p� �' � ' �� <br /> - ---- � ,,. <br /> �, ':,��'tJ�'1t�r� '•��i�ui•:n�, �n..� tiv.: ��.e,s4,l:Lf��:.^.l � <br /> t,� <br />