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✓ <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> ; :�;� . <br /> Our records indicate that a back�vater prever}tion device must be instailed on the sewer <br /> connection at the address idenlified,�on the enclosed letler Please help us verify that our <br /> information is correcl by answering the folloe�i'q�quesfions about your property. <br /> •,r <br /> Do you have a basement? Yes� No � ��. <br /> I!yes, does il have plumbing tixtures (sink, toilel, floor drain, etc.)? Yes� No ❑ <br /> Do you have a backwater vaWe on your sewer line7 Ye�No ❑ Don't Know � <br /> Uo you hava a grinder pump in your•basement? Yes� No ❑ Uon't Know ❑ <br /> Name: �" ' ��.�L� �.I��I I�.��S� � <br /> Property address LZ� n /, v C ' ��F� <br /> Phone 1: (��7 �/ — � � a O JU'Phone 2:�'IZ S- 3 7� �� �f <br /> Email: ___��.��'!1 • r� C � C r�R'_ r Cp �✓� <br /> t '`'; �� �( R^: . . � <br /> ����w;�'��.�:�3�:is:��l.1,�,'�"�' .� t'��.i�._:fi,,� , �� �!�!!� <br /> L•:Jr.�v'�;��m <br />