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. . .. . �'.�a.�t�'ON-.._.. . <br /> : BACKWATER PREVENTiON D��E PROGRAM <br /> , <br /> Our records indicate Ihat a backwater prever�tla��device musl 6e installed on your <br /> sewer conneclion to comply with the new ordiri�nce. Please help us verify that our <br /> information is correcl by ansvering the following questions about your property: <br /> Do you have a basement7 Yes� No L] <br /> It yes, does il have plumbing tixW res (sink, toilet,(loordrain, etc.)9 Yes �I No ❑ <br /> Do you have a backwater valve on your sewer line7 Yes ❑ No ❑ Don't Know �j <br /> Do you have a grinder pump in your basement? Yes ❑ No � �on't Kno�v ❑ <br /> Name: �A��ZT � � ���� <br /> Property address: t�3�. �,�'�-C�C��—��� ��7 �o� <br /> 1, � lll <br /> Phone t: �1ti5.��� Ol� � Phone 2: �� � .,��� ' Q <br /> Ernail. �l l F���l� � �1 i4"�� G'� ��'ti�-- -- -- <br /> � } . . i • , 3T 1 . . <br /> Qa . <br /> a`1 y l.. � 1 �. �.� . 'l. .._. � .�_ . ._....��.. \.- <br /> _LTJL�Y� .�___ ....._�.i. .... . <br />