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��s..� - -- - <br />� <br />BACKWATER PREVENTION DEVICE PROGRAM <br />Our records mdicale that a bacl.v�ater prevention dewce must be installed on your <br />see�er connection to comply with Ihe neva ordinance Please help us verify that our <br />r,formation is corred by answering the (ollo�.ving queslions about your property: <br />f'o you have a basement7 Yes� [�No [] <br />If yes, does it have plwnbmg (i�& (sink, toilet, floor drain, etc )7 Yes `� No L; <br />n <br />Do you have a backwater valve on your sewer line� Yes ❑ No ❑ Don't Knuw 7� <br />Do you have a gnnder pump m your b3sement7 Yes � No � DonY Know� <br />Name <br />.J � u h <br />I'roperty address' � y/�����`iA �� <« f `_�_'_��_L <br />' Phonel �1,_SS� Phone2 _ <br />Cmad _ 17�L1�C1v�� �1:7.�� �J_� 4�i�5i, ���i� <br />� •�► • . ;11` i <br />-- � <br />; <br />• <br />: ;•, . ��ti b . <br />,.,�t l� d., . d ,...i.:, �. � � .. �d...� � _ t.4 ■ <br />