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�°�;� , <br /> ��� � <br /> � �'{A1� p � 20�� , <br /> U�I,r � �O <br /> r.. <br /> � '1�, <br /> DECLINE FORN1 <br /> SEWER BACKWATER VALVE INSTALLATION SEVVER L PROJECf <br /> ❑ I wish to decline the offer for installation of a sewer backwater valve by the City <br /> Contrector. <br /> ❑ I do not qualify because one or more of the following conditions are appiicable: <br /> ❑ My house does not have a basemen[ <br /> ❑ My basement does not have any drain fixtures that go to the sevaer <br /> � I already have a sewer backwater valve. <br /> Name: ��� �ir'. s' ! �l L-tJ �� b" <br /> � <br /> Address: I .5 I 5 �-G M ��� �'cd �`v�- <br /> Phone: �! .2 �, _ � `� ? - �2`� ,/ � <br /> NOTE: <br /> If you are uncerlain about your bar^ment plumhiny situation - complete the "Permission to <br /> Inspect" form and the Ciry will perform .�r ��� uon and determine your specific situation. <br />- � <br /> � <br />