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�,,; - --- --- --- ✓� <br /> '� . , BACKWATER PREVENTION DEVICE PROGRAM <br /> � Our records indicate that a backwater prevention dev�:e must be installed on your <br /> sewer connedion b comply erith lhe nev� ordinance. Flease help us verify that our <br /> in(ermation is correct by answering the tollowing quesiions about your properiy: <br /> Do you have a basemen;7 Yes�No [ <br /> If y?s, does it have plumbing fixtures(sink, toilet. Floor dra,n, etc.)? Yes� No ❑ <br /> Do you have a 6acfcwaler vaive on your sewer line7 Yes ❑ No ❑ Don't Know � <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Dodt Kno�v �` <br /> Name: _�QI_v `_��� �^� <br /> /_ /'l K � dt ( <br /> Property address: __ �V�U _ v�' `�J / ` v� � <br /> Phone 1:� ��D �Cr��_ Phone 2. _ <br /> Emad — ---- -- <br /> : � i �r. ; <br /> . i . ;o� ��. �e� ' r --- . <br /> �..rw-.�� ��a.v-�.... . <br /> ���1_� ._H �_ _. ]G\.� �.. . ._ _.� . _ � .. . . - .. . _ . �. 1 : <br />