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•'J ( <br /> - BACKWATER PREVENTION DEVICE PROGRAM <br /> ��;: <br /> Our records indicale lhat a backv�aler prevention device must be installed on your <br /> sewer conneclion lo comply with the netv ordmance Please help us verify that our <br /> information is correct by answering the folbwing questions about your property: <br /> Do you have a basement? Yes � No [ <br /> I <br /> If yes, does it have plumbing fixWres (sink, toilet, floor drain, eta17 Yes No ❑ <br /> Do you have a backw�;er valve o� your sewer line? Yes ❑ No ❑ Don't Know �] <br /> Do you have a grinder pump in your basemenl7 �es ❑ No !] Don't Know � <br /> Name: <br /> CR�.o�.f )-�OLI�M�� <br /> Property address: � � �� 1�� ��� � �� ���� �t/� <br /> ` Phonel: ���' �� � ' �,�b , Phone2: 2D� ' �� S " �i7 �_� <br /> Email: _ ._ <br /> _ . , � , � ..� i r . <br /> ? .-3: �._---J,J � ' 1 � � i <br /> .•,_.-- — --- �� � � _ :'—_ _. . _ .l ..��_ ,�:- <br />