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J <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a back�valer prevention device must be installed on the se�ver <br /> connection al lhe address identified on the enclosed letler. Please hetp us verify that our <br /> intormation is correcl by answering the following questions aboul your property: <br /> Do you have a basement? Yes � No ❑ <br /> If yes, does it have plumbir�g fixtures (sink, toilet, floor drain,etc.)? Yes�No � <br /> �. ..— �-- <br /> Do you have a backwater valve n your se�ver line? Yes � No ❑ Don't Know ❑j <br /> 5eWe'� linereP�� ll. • <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know '� <br /> Name: �a"f� 1� � �dl�q0.Y� <br /> Property address: � S � I /1'IA� /Q. <br /> Phone 1: _ C���il-oa6 y Phone 2: aZ��' 7$b'D 9Q'J <br /> Email: (71� .��c�� O�tQY�2��'�Q,� <br /> �......... : , . .� r. � �i� ,t ,4 • , <br /> 1 '�� ' 1� I 1� � r: � <br /> �`"`_____"_!_ .Lu::�i_[G.'�.�..._.L:..._.. ' . . _ ._._._.._.... � .. ...C.���...il . 1 i_ <br />