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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a ha�kwater p;evenhon device must be instalied on your <br /> se�ver connection to comply wdh the new ordinance Please help us venfy that our <br /> information is correct by ansv✓ering the following questions about your property <br /> Do you have a basement? Yes � j No �' <br /> If yes, does it have plumbing fxtures (smk, lodet, Iloor drain, etc )� Yes � �do [ <br /> Do you have a hackv�ater valve on your sewer line� Yes ❑ No� Don't Know r <br /> Do you have a grinder pumn in your basement? Yes ❑ Nn� Don't Know ❑ <br /> Name: Mr. 8�Mrs. Merlin ).Verhoeven <br /> 1d31lombaidAve. � ! <br /> Everet�, WA98201-1626 I � <br /> Pwperty add•s � ' ---.-- I <br /> Phone 1: �C.�v�� O�d � � Phone 2: "/�� o��o c� 7 9 �y I <br /> Email: �/v/l�l�. - --- -- � <br /> ------- . 1 j•. ilii�'t'ol' � '�'�'�!1�� S� I <br /> ���I _ -. __ ;_.r.,Y.,—,:c';;��a,!',�:l.�_�_��:_ �.� :�'sl!.�.Slt�,�St,`i..!�. _.:_,�,.:!i�: �,t��P_� <br />