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BACKWATER PREVENTION pEVICE PROGRAM <br /> . :�,fi.: <br /> Our records indicate that a backvdatei p�eaeMion device must he irstalled on your <br /> sewer connec,ion to comply�vith the neW o�tlinance Please help us verily that our <br /> information is correct by answering the foll�wing questions aboul your properly: <br /> Do you have a ba<_ement? Yes �No ❑ � <br /> If yes, does it have plurnbing fixtures (sink, toilet, tloor drain, elc.)? Yes ❑ No Ki • <br /> `t'��/ <br /> Do you have a backv+ater valve on your s.wer lin�� Yes ❑ No ❑ Don't Know�/I <br /> '''���,,,111 /� <br /> Do you have a grinder pumo in your basement7 Yes ❑ No ❑ Don't Know�y(� <br /> -� <br /> T� <br /> `' �—�p �� � <br /> Name!�� l C �0`�' li.�%1_.,� <br /> ( ^ �J I ) <br /> Propertyaddress � { � � ^�v�—��-�—`��V� <br /> Phone 1: �a���.7�_�[�PII'one 2: �t v�CJ'� �7 �- ����1 <br /> Email: �VvO� � �✓V ���`�� `� � <br /> � ' ' v <br /> _.,�......_. ..�..�.. I 1. � . { �� . ' I � I ' �� � � I , <br /> , ._�:_:;�h.'..�.�_—_ _. c ....— _.__ .. . .__•!...__ �:d <br />