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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backwate� prevenlion device must be installed on your <br /> sewer connection to comply with the neJ�ordinance. Please help us verify that our <br /> infonnation is correct by ans�vering the(ollowing questions about your property: <br /> Do you have a basemenl? Yes�] No � <br /> If yes, does it have plumbing fixtures(sink, toilet, floor drain, etc.)? Yes�f No ❑ <br /> l� <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know� <br /> Do you have a c�rinder pump in yo�r basement? Yes ❑. No ❑ Don't Know� <br /> Namo: ( /`�Ar. �.Q� �j /r%�t/�P_Y�c �_. <br /> Property address _ /'� � � ' '' �"�' ���� "' ��P <br /> Phone 1' ��� �-Z�/ ,��,7:/� Phone 2 �/ � �� D 7� " � �.Z� <br /> F�,,,�� __ ��/��`i__�7^ol�If?en_c�h.� � A�/� , /ial�'i <br /> -- -- -- — r . .. .,, �����1���'►1'� �'. . <br /> ;�rl_ �• (�.t�.��Ll���_,;:����3a� r.i��_����:�d.:�:��.1�� �,k <br /> ��:�� <br />