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� / <br /> BACKWATER PREVENTION DEVICE PROGRAM � / <br /> Our records indicate that a backwater prevention device must be installed on your <br /> se�ver conneci�oh_to wnipiy wdh the ne�v ordinance Please help us verify that our <br /> in`ormation'is Cor�ec,t6y answering the following questions about your property: <br /> � . r��! �°.%.-�' ...,.. �,:,�. <br /> .•i ..:�� -:. <br /> Do you have a basement� Yes �No ❑ <br /> If yes, does it have plumbing tixtures (sink, toilet, floor drain, eic.)? Yes r i No ❑ <br /> � Do you have a back�vater valve on your sewer line? Yes ❑ No ❑ Don't Knov�� <br /> Do you have a grinder pump in your basement? Yes ❑ Nopj` Don't Know ❑ <br /> Name G P i C_ V �hl'� �l lll.�l� /� (/�t(..S OI`I <br /> Property address. <br /> �� 1��7 �--CJWI�(�I : �/G ., �V�.1Z�TY ��a�� <br /> i <br /> Phone 1. �_``�_�3�3' ����J Phone 2: <br /> i 1 <br /> Email. _��,�7�� SOJ\ r _ r ln����CA1�1�1 <br /> I ��� � j .fl �I � <br /> � * `"� 1 �!:y��liJ�;t ��S�it1�,� ! M ����,:I�.11UL.: ''� !�� _ 1.1. _` 1:_.e�l5i�"iGi <br />