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`/ i <br /> BACKWATER PREVENTION DEVICE PROGRAM � <br /> Our records indicate lhat a backwatcr NrevenUon device must bc insfalled on your <br /> s?�.ver connection to comply tvith the ne�ti�ord�nance. Please help us venfy that our <br /> in�ormation is correct by ans�vering lhe follovnng ques4ons about your property: <br /> i <br /> Do you have a basement? Yes �No ❑ I <br /> If yes, does it have plumbing fixlures (sink, toilel, floor drain, etc.)? Yes �'No �I <br /> Do you have a backwater valve on your sewer line? Yes ❑ No �'Oon't Knov+ ❑ <br /> Do you have a grinder pump in your basement9 Yes ❑ No �,✓Don't Know ❑ <br /> a�Cc � }')') ![,�.�L�..� <br /> hlame'.�- - -(/1 -- — <br /> ?roperty address �b O J �� � _ _ _ <br /> Pnone 1. yo75-0�5�- y6 T/ _ Phone 2 -- - - — <br /> FinaiP _ ___. _. _. . - - ----- - . --_._ <br /> , .� --� . . ��x1' � , i <br /> 1 ..�,.� , <br /> � � <br /> _ t�_ . � �i-' .9' , . .. , _ . <br /> . <br /> II <br />