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�� <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate tha; a backwaler prevention device must be installed on ihe sewer <br /> connection at lhe address identified on the enclosed letter. Please help us veri(y that our <br /> information is correct by answering the Ilowing questions about your property: <br /> Do you have a basement? Yes No ❑ <br /> If yes, does it have plumbing 5xtures (sink, toilet, floor drain, etc.)? Yes � ❑ <br /> Do you have a backwater valve on your sewer Lne? Yes ❑ No t�Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes i] No Cj�on'f Know ❑ <br /> Name: �C`Jd'��/ / ���I e c� S �'�2 <br /> Property address: �J l� � �-� h � r Gl <br /> � Phone 1: ��5 ✓��—�T� � F'hone 2: _ <br /> Email: _/�j_ ��3' ZG�L ��c7 SdY:-� � <br /> r�- �, �� -�-� <br /> � ,-: . , , , tj,, ; <br /> �t�: ' � � � <br /> �" �'. � � � 1.::�_1..�. � r J.�_._.. . �..��._ �,. � `.LI�.__�.�. i . .. ,�. � .... .._ �i� � <br />