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BACKWATER PREVENTION DEVICE PROGRAM <br />Our records indicale thal a hackwdter prevention device must he installed on your <br />se:�:er connedion to comply with lhe new ordinance Please help us verify that ou� <br />�nformation is correct by answering the follo�ving questiors atout your property <br />Do you have a basemenl? Yes � No -f <br />If yes, does il have plumbing fixlures (sink, toile;, foor drain, etr, l? Yes � No [j <br />Do you have a 6ackwater valve on your sevrer line? 1'es j_� No � Don't Knc�:� [� <br />Dc you have a grinder pump in your basement7 Yes ❑ No � Don't Know 'Vi <br />Name - -��� --F�'� ---- <br />Jt, n---- <br />Propertyaddress J�(;ZZ I���,�crr i�� iS.1� ������LrI" I <br />Phone 1: �2�� L��C�G��C� Phone 2: __ <br />Email:_-_�VYI�YLGQn ��G�r�}�u�_'_-�d� <br />� _ <br />- , - - --- � � � . � , <br />1 1 <br />_ , _,,. _ . . i � � <br />. � ;.t „ � , ��' <br />---�--__.-------�—�_ . ..t�._ :.._..- - _ _.____ . �, _._.�..._ <br />