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•'.n..:r.R1�:f;�J}..Y;.""` .. . o�. <br /> .1',.. <br /> . ..J�. ' . � . . 1.., ' <br /> ��} <br /> .J.l.. �'1: , .. . . <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicale that a backwater prevenlion device must be installed on your <br /> sewer conneclion to comply with the new ordinance. Please help us verify that our <br /> information is correcl by answering Ihe following questions about your property: <br /> Do you have a basement? Yes �Nc ❑ <br /> If yes, does it have plumbing fixtures(sink, toilet, floor drain, etc.)7 Yes� No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No �j Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes ❑ No �Don't Know ❑ <br /> Name: / /M 'J ,Y=Lv� <br /> Property address: �Sd� �U�P�e(�,r. ✓ <br /> Phone 1: � Z s�- ���L y / Phone 2: <br /> EmaiC � c�C�c..) e � � ld�CZ�lN1C�.i� C I.Y�L <br /> �� p,••� <br /> lr4�•Yf�� .�,�ri►:a . ,.�, �,. a��1l�i.L...1F <br />