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�_ <br /> ' � .. •.';�;: <br /> . . �t� ; <br /> " BACKWATER.PREVENTIC�I�,DEVICE PROGRAM <br /> Our recoris indiczte thal a backv�ater prevention device must be installed on your <br /> sewer connection to comply with the new ordinance. Please help us venfy that our <br /> information is correct by answenng the following queslions about your property. <br /> Do you have a basement7 Yes �No � <br /> If ye=, does d have plumbing fixtures (sink, toilet, floor drain, etc.)? Ves�No ❑ <br /> Do you have a backwaler valve on your sewer line? Yes ❑ No ❑ Don't Knav� <br /> Du you have a grinder pump in your basemenl7 Yes '� No � DonY Know�' <br /> Name: �e \�4_Q�Q�A ��� '��4�1� <br /> � Pro{ierty address' _L`'[��i �V�VIL'Q.1 r`V Q� <br /> Phonet �Zsr Zsb-"17i�Q . Phone2 � 1i7 - 3a3 - � 1« <br /> Email: ��1_�� \�" ��D � e.f • C�� <br /> ;�;:� � '�i�i�l�.�i'.i:��•r.�,��Y"../tIv711F''�1��'�{..�.�%'�'ll'Li�17•.� <br /> 1 <br />