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BACKWATER PREVENTION DEVICE PROGRAM <br />Our records indicate tl;al a backwater prevei�tion devir.e must be inslal�ed on your <br />se�ver connecUon to comply with tne new ordinance Please help us verify that our <br />inforrnation is wrrect by answeriny the 'oilo�ving questions about ycur properly <br />�o you have a basemen!? Yes � No � �o-y Aµ�,,. <br />If yes, does it have plumbing fixlures (sink, loilel, f�oor drain, etc )? Yes ❑ No ������ <br />Do you have a backc.�ater valve on your se�•�er Gne7 Yes ❑ No ❑ Don't Know � <br />Do you have a grinder pump in your basement? Yes ❑ No Q�Don't Know ❑ <br />Name .J_�_F� " G �/o /7 .✓ 'J o N <br />/ <br />Property address• �„��h�/ � � c r' /��f-��"��• •� <br />Phone 1: �.�.�:-1�«�1.-S�Phone 2' <br />Email <br />�,�, , � ''; <br />R1.�?�}� `J'.II'�'�;._'._.'• <br />. <br />.. ,i ;�. ���h.j��, l; . • . . , <br />;,'. <, •. <br />,�:J1.11i���1'�.�t,..�-_.�1:1:,.�..fl,1. m� <br />