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��-� <br />,. . / <br />� - BACKWATER PREVENTION DEVICE PROGRANi I <br />Our records indicate ihat a back�vatrr prevantion dewce must be installed on yo�r <br />sev:er conneclion to comply with the new ordinance Please t��elp us verify Ihat our� <br />informa�ion is corre�i by answering the foliowing questions aboul your property ' <br />Do you have a basemenf % Yes�i No ❑ <br />If yes. does it have plumbing (ixlurc �(sink, toilet, floor drain, etc.)? Yes � No 'i ] <br />Do you have a backwater vatve on your sewer line� Yes ❑ No J Don t Know � <br />Do you have a grinder pump in your basement� Yes 0 No _] pon't Know J�( <br />Name �1J/�1-4_�i�a��/%1� CK�L'G {(�r7if _0 J-/�ul/ �YT �S1t1le <br />Property address �jz. �-Z %`�O / <br />�---- <br />Phone t yj�,1 �p'����,..� Phone 2� Z�� b�� � T1� <br />Emai; _t=• <��N_L�.lI_s_`�k%f/�f�'ri7,U-�--� — - <br />— — . -- -?-- � _ , ' _��_—_� <br />� <br />�t _ . _. . --- � � <br />