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� . � � <br /> ;. <br /> BACKWATER PREVENTION D�VICE PROGRAM <br /> . ,,�. <br /> . . ,., - . <br /> Our records indicate that a backwaler prevenlion device must be installed on your <br /> sewer conneclion to complp 1t�th the new ordinance. Please help us verify ihal our <br /> intormalion is wrtect by answering the(ollowing questions about you� property: <br /> Do you have a basemenl7 Yes �No ❑ <br /> If yes, does it have plumbing fir.tures (sink, toilet, Boor drain, elc.)? Yes / No ❑ / <br /> Do you have a backwater valve on your sewer line7 Yes ❑ No � Don't Know [�+j <br /> Do you have a rinder pump in your basement? Yes ❑ No ❑ Don't Know �� <br /> , <br /> Name: � N�G/I� Q'�:il:;;..: ..(�� IC-� <br /> ,l � ' <br /> (� �7 'i G . <br /> Property address: � !_J( __'�Q•_ti-`�- � � J� — <br /> � f -< �rf !1, �" � � -1� <br /> Phone t: L� � ? ✓'�o �'� j�T� Phone 2: � r'� �'= P •' �" <br /> 0 1 <br /> �d ��m.� �; �: ��. ��t.:�t��cs�� ;? .P� <br /> Finail: ___ _ --- — <br /> . ..;T-nu . ' II �t �t\Y � �f II � <br /> } . i ( <br /> � �`�., I • r ���.i'! 1��.. .� 1 I I�1� .� � �i - �... ,_�� <br /> _ _ _ _ . . : � .�. <br /> y:�:__ T ---3- . v' u '. . . _ . .. -.� � . .._ .._ . <br />