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r, <br />: . ':���;.: � . <br />,. .`::... . <br />( '. <br />. � - <br />� � <br />9 �l::� <br />BACKWATER PREV�N`�''I;AN DEVICE PROGRAM <br />Our records indicate that a backavater prevention device must be installed on your <br />sev.•er connection to comply wdh the new ordinance Please help us ��enfy lhat our <br />infcrmation is correct by answering the tollowing questions about yo�r property: <br />Do you have a basement? Yes�o ❑ <br />I( yes, does il have plumbing fixlures (sink, toilet, floor drain, etc )7 Yes �No ❑ <br />Do you have a backwater valve on your sewer I,ne? Yes ❑ No ❑ Don't Knova �✓ <br />Do you have a grinder pump in your baseme�t? Yes ❑ No [j Don't Kno�v � <br />. � . <br />I�ame: .� � W \p. �V�' V'�: "� � • �U�.f v�.aL� .nn� <br />Property address' �� � ^��►'�� � _ �� "" `-""" �g Z� ( <br />Phonel:UZS 2�� �_ Phone2: �'.ZS��� � $��� <br />Email: �,��+'J�.l�.—v_`o� W�9�./I � �'�✓1 <br />, : •,, <br />.:l ���1! ' � <br />; .. <br />i. � , .',�+,. _ . <br />�La�4i!'�,:.:�.i� .>.�.•:.:.6. <br />