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� � <br /> RACKWATER PREVEtQTiON DEVICE PROGRAM <br /> Our records indicate that a bac!d4ater prevenlion device musl be installed on your <br /> sev:er connection ro comply�vilfi the�nev.�Ordinance. Please help us verify that our <br /> information is correct by ansr�ering Itie following questions aboul your property I <br /> Do you have a basement? Yes �` No ❑ I <br /> If yes, coes rt have plumbing fixtures (smk, toilet, floor drain, etc.)� Yes�No ❑ <br /> Do you have a backwater valve on your sewer line� Yes ❑ No ❑ Don't Know�CI <br /> "`\ <br /> Do you have a annder pump in your basemenl9 Yes � No�Don't Know ❑ <br /> Name U� ��r� � <br /> y t�op, - �.�c�. c�- � <br /> Property address. <br /> .J <br /> Phone t�l`n 'Z��—�1J�C��Phone 2' "'` �` �C7 ^T�� :�,�.Y� <br /> Email' 1'1��. �tl������.�`L� ' — <br /> v- � � <br /> 1 11 11 ` '� � V���,+� , ... ::1 ; ' . ,'t <br /> . ' ._ . . .L11�'��Yl'CJ,1�ll_J�.��{II1�1� ��'���r'�, I I.�..��l�l.� <br /> 1 <br /> Yr. <br />