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, <br /> , ✓ <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backwater prevention device musl be installed on the sevder <br /> connec6on at the address identified on the enclosed Ielter. Please heip us verify that our <br /> iniormation is correct by answering the following questions about your property: <br /> Do you have a basement? Yes�No ❑ <br /> If yes, does it have plumbing �ixtures (sink, toilet floor drain etc.)? Yes � No ❑ <br /> Do you have a backwaler valve on your sewer line? Yes ❑ No ❑ Don"t Knova,� <br /> Do you have a grinder pump in your basement7 Yes ❑ No ❑ Don't Know� <br /> Name: /l��� / �' ���� <br /> Property address: ��! �c:�"� �l�-�"C'��1��— <br /> Phone 1: y7S . Z �/. y�S� Phone 2: _ . <br /> Emai�: 'f�� � Pr+� 7�L���i/�'°�c� l � CC�I�`� <br /> � d�{��.� :,y{�'; �, ,1. �'.�:�;{,��'Sk'���;�,�.,.., <br /> . _ _._ --_ �Si��'���.t�.J: ] .iiy�'�i��t'1r�Y.i��l-�{�Lti_��I'�':f.:iL•�l��r. ��:. a'Xwj.7 <br /> :�iYS�. <br /> `1�U.' <br />