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— -- -- ------- -- --- -- "�"''.r.�"i <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> i <br /> Our records mdicate lnat a back���ater prevenhen device must be inslalled on your , <br /> ;:ev:er connection to compiy vaitn Ihe new ordinance Please helo us venty ihat our <br /> miorrralion is correct by ansv+ering the foilowino quest��ns about your propery <br /> Uc ��ou have a basemenl7 Ycs [� No ❑ I <br /> if yes. does d have pl� �bing flxtures (sink, toilet, floo� drain, elc )� Yes � i�' I <br /> Co you have a back�vater valve on your sea�er line� Yes ❑ No C��on't Kno�v ❑ II <br /> Do you have a grinder pump in your basement� Yes _ No �bon't Knoev ❑ , <br /> Naine --1�� _�+� l � ���— - - — <br /> Properlyaddress _`,_'_I.�_ �� C.�L-{('� �.��.�^P� �` ' �^ <br /> Phone 1 ���"'�L7 9 -! .� �F�ione 2: _ _ � <br /> Frn,�il --- — - ---- <br /> - - .�i{ {�(�]�I�1 fr�,r1y4r�n`�i r� { <br /> - - — - ----���rt';��.j dJ�4�.f,:�:i.,�:''�+��fi1�;r,N_'���y.l':i'r'�LiPi!u l�� � <br /> I <br />