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� <br /> . ; - . <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a hack�vater prevention device must be installed on your <br /> sevrer connec�ian to comply with the new ordinance Please helpLs venfy that our <br /> mformation is correct by answering the following questions aboul your property: <br /> Do you r.ave a basement7 Yes,y f No ❑ <br /> 7C <br /> If yes, does it have plumhing fixlures (sink, toilet, floor drain, etc.)? Yes No ❑ <br /> Do you have a backwater vaive on your sewer line? Yes ❑ No ❑ Don't Know�(l , <br /> �-� <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Kno�v � <br /> Name _ I �{ Y � I"V1 , I Ci�/ � f�Q.y I V� I�llAS��� <br /> Property address. G� ( � t�� �� U�{ '����/• ' �"V� <br /> Phone 1:2���7)���� Phone 2: ___ <br /> . Email: �1�1R{�l/� I'vl�� �Pi��}I V��i'�L '�{�L�C T �. 1�-Qi� <br /> f <br /> ,,.. .��.•i4j:t;�'�1 i� ��,.r'.,�k:� :�. ( <br /> " ' �__ ' " � :�t�1���71�r.!'��::i:a�_ .i.ivt1.f32'l�t�:���1,f•!�f��J�:L1.L, Y.aE <br />