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� _ � ✓ <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backvaater prevention device must be installed on your <br /> �' sewer connection lo comply v:ith ihe ne�'�ordinanw. Please heip us verify that our <br /> informalion is correct by anstvering the following questions about your property: <br /> Do you have a basement7 Yes �No ❑ ,-� / <br /> If yes, does it have plum6ing fixtures (sink, toilet, floor drain, etc.)? Yes ❑ No � <br /> �`Y�/ <br /> � Do you have a backwater valve on your seerer fne? Yes ❑ No ❑ Don't Know IY <br /> ��.5 <br /> Do you have a grinder pump in your basement? Yes ❑ No �'Uon't Kno�v ❑ <br /> .� <br /> Name: ��1,�4L—I' �- �-��"`�'1��e� <br /> Property address ��Q'�Q�hp _ �� � �`�� � <br /> Phone 1 _(2��(Z �'t D y2 Phone 2. N ,�_ �� <br /> Email --����-L13=.��— C.�� • C c�i�l.� -- <br /> —�+�' �, �1t, "� •f' J' iL. ttt; • <br /> �— --- :s�C,S�i�l��.i!d1L'L:�.��.1.,'t' jll� r�,.�.L�;._'.•��E1Y::.. ��. <br /> il•. <br />