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1,` Ca l�l e� �c.f �� ,i C 1,�0/ k-S .� � � o.�iz�nGe � -t'or �/ <br /> La u r� �-o ca � c in c 91- <br /> BACKW.4TER PRFVENTION DEVICE PROGRAM S� tie � �'n a�'P� <br /> a � 'f0 CoM e. 'f0 "��G <br /> Our record� indicate lhal a backwater prevention device musl be installed on your ho�,se . <br /> sewer connection to comply witii th2 new ordinance. P!ease help us verify thal our <br /> in(orma;ion is correcl by answering the tollowing questions about your property: �UL� Ca�/ -�l, <br /> ti e � ye-�. <br /> Do you have a basement? Yes� No ❑ <br /> I(yes, does it have plumbing fixtures (sink, toilet, floor drain, etc.)? Yes�] No � <br /> Do you have a backwater valve on your sewer line7 Yes ❑ No ❑ Don't Knov✓�] <br /> Do you have a grinder pump in your basemenl? Yes ❑ No ❑ Don't Know� <br /> I c <br /> Name: ��Vr�� L- I n � S � <br /> Property address � / v� n � � �e L V � " ' � � " zo ' <br /> ��1, Phohe 1�'T.z,1��a � !�/��� Phone 2��� � � 3�- � j �' 9 V�J' � <br /> [mail ---�a � � e l54�S�t2 � � r J' � �<�1 M o�� , co�'�. <br /> I � — - - �-------� <br /> �,1�, -_ __ ._ - ----,-� . � . _ .a.�!! <br />