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i . <br /> BACKWATER PREVENTIO��VICE PROGRAM <br /> �. <br /> �. <br /> Our records indicale lhal a backwater preu�ntion device must be installed on your <br /> se�ver conneclion lo comply v�ilh the neuf�ordinance. Please help us verify that our <br /> mformation is correct by answering the follov�ino questions about your property: <br /> Do you have a basement7 Yes Q� No _I <br /> If yes. does it have plumbing fixtures (sink, toilet, floor drain, etc )? Yes � No ❑ <br /> Do you have a backvdater vaive on your sev�er linc7 Yes ❑ No ❑ Don't Know ,�,SZj <br /> Do you have a grinder pump in your basement? Yes ❑ No � Oon't Know ❑ <br /> hame �.J.i�5�—�� sr�����-- <br /> Property address: �c.� d d � 1�� S 1_Y �L Q I � L���L'��W'l,__I ��• � � <br /> Phone 1 I�� 5 '� }, � � }�� Phone 2 `� <br /> EmaiP _�- � � — <br /> . � � ; <br /> _. ..... �.. .. , .. _ ' `�il ��+' . .. . s <br />