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�� �� <br /> �� ��' ��� <br /> f� <br /> 5� ���� ` _ ,- ��� <br /> � ''� <br /> o�, �� <br /> ks <br /> DECLINE FORM <br /> SEWER BACKWATER VALVE INSTALLATION SEWER L PP.OJECT <br /> [� I wish to decline the offer for installation of a sewer backwat:er valve by the City <br /> Contrador. <br /> ❑ I do not qualify because one or more of the following conditions are applicabie: <br /> ❑ My house does not have a basement <br /> ❑ My basement does not have any drain fixtures that go to the sewer <br /> �, I already have a sewer backwater valve. <br /> Name: �Z�C /�c=Li«2— <br /> Address: 1`f z8 L�✓�3�2�� �vL-' <br /> Phone: <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 />