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d <br />. _ . ;,�' <br />- :�ACKWATER;PREVENTIbN,D�VICE PROGRAM. <br />,,. . , -; ,, , } ,: , <br />~ Our records indicate (hat a backwater. p�e,�ientibn device must be installed on your <br />seyuer corinection to comply with ihe ne�,;qcrlinance. Please help us veri(y that our <br />informalion is correct by answermg lhe� dllowing questions about your property: <br />Do you have a basement? Yet [�No ❑ <br />If yes, does it have plumbing fxtures (sink, toilet, Floor:drain, elc.)? Yes [[�No ❑ <br />Do you have a backwater valve on your sewer line? Yes ❑ No [.�Don't Know ❑ <br />Do you have a grinder pump m your basemenl7 Yes ❑ No [�Don't Know ❑ <br />Name: • I� 1Ci,i/`I Cf vl/1 'e. ����� <br />Property address Q_� � �� �,�? L � <br />Phone1:7�5-2/0-�p��phone2: �2^i ^.33/'��%� <br />Email: _ -��' ����. � 2� �' i'�"A�f �._—�_�'i'�. <br />I• � <br />lA: ��Il <br />� <br />.� il�:. 'Q•- _ ".. '���` � F'"'P�':_' <br />(J •_" , ��•,'b`'atdlNiiiii_:, . A,�` ^,.'... <.R-P_-ti__ � n.._. ;,;"P,� <br />.,.. , <br />i 5 •, �� <br />'i �'_ �,'=Ll:i.l.�iu. <br />