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1 <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> . Our records indicate that a backwater prevenlion decice musl be �nslalled bn your <br /> se�ver connect�on to comply viith ihe nev✓ordinance Please help us venfy that our <br /> information is correct by ans•:ering the follov:ing questions aboul your property: <br /> Do you have a basement? Yes ,� No ❑ <br /> If yes,'does it have plumbing fixtures (sink. toilet, floor drain,`eta)? Yes �i No [� <br /> Do you have a backwater valve on your sewer line? Yes ❑ No'gj Don't Know ',_j <br /> Dci you have a grinder pump in your basemeni7 Yes ,J No C� Don't Knov� ❑ �U1'�(.r �+ <br /> _ . pL,v`��", <br /> ` ��� <br /> Name: .C-'1'EO� �' U�irKJ�'Z��%_ �_( C��lYtC.C'�:�'i. .�- <br /> � � <br /> I��%nl (`D��,� �a�;� �� <br /> Property address _ —�__��'L�� � - <br /> Phone 1 ��S-�� 3-��-C I• .__ Phone 2 Lt2.C' C 17-� '_-77,C� <br /> FinaiP _�I�C,�IC�� � C'C�'O✓�CC2$•� . 11c��� {:JC�.Y�1F�a � � �t(i�LL`��51� <br /> -- + •� •i.���Q�i� �4•1`�M,��,�:���� � �.�- • <br /> � -- ------ - —r---�--�.. WJ�'t�i31ld:4ili:�iii� ��' .•i l,L3i�'�.1S1�iL!J3'{{lsf��l.�I�i ei:'I:�.l�%; b�� � <br /> .• <br /> � <br /> � <br /> I <br />