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BACKWATER PREVEN i ION DEVICE PROGRAM <br /> Our records indicate thal a backH�ater prevention device must be installed on your <br /> sewer connection to comply wifh the nev�ordinance. Please help us venfy that our <br /> miormation is correct by answering the fnl:owing questions about your property: <br /> I Do you have a basement7 Yes �No ❑ <br /> If yes, does it have plumbing GxWres (sink, toilet, floor drain, etc )? Yes f�No ❑ <br /> Do you have a backwaler vah�e on your sewer line? Yes ❑ No ,�,Don't Know ❑ <br /> Do you have a grinder pump m your ba�ement9 Yes ❑ No f�..Don't Kno�v ❑ <br /> c <br /> Name Q'�A,UG.� �• � 1�9�.r <br /> a �1` <br /> Property address: _� 2� � ��� L��� <br /> Phone 1: /ZS Z�7 S�3 > Phone 2: <br /> Email: O�O�.:�Ctivl-- r�L� �C\_��. 1 ' GdWI <br /> '_" - �, . I � 1 � l ' ' ' � • ' ��t � { � :� , <br /> --------- •- --=�' -- •--t- - � . . _._ _<<. .__ - - - �'iL <br />