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����� ��� ���, <br /> MAR ' 0 2011 I � <br /> PI_li?l:l:' i, �� ; ;� <br /> �JECLINE FORM <br /> ' SEWER BACKWATER VALVE INSTALIATION SEWER L PROJECT <br /> �',� � I wish to decline the offer for installation of a s�.•rer backwater valve by the City <br /> \ � Contractor. <br /> ❑ I do not qualify because one or more of the following conditions are applicable: <br /> ❑ My house does not have a basement <br /> � My basement does not have any drain fi�ures that go to the sewer <br /> ❑ I already have a sewer backwater valv�. <br /> Name: �\ 11... �J�� <br /> Address: ��1c�. l �mba�'�'"� <br /> Phone: y�s� ���-�10�$� <br /> NOTE: <br /> If you are uncertain about your basement plumbing situation - complete the "Permission to <br /> Inspect" form and the City will perform an inspection and determine your specific situation. <br />