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- , ; . <br /> � <br /> � <br /> ,:: <br /> � BACKWATER PREVENTIO�FI DEVICE PROGRAM <br /> Our records indicate that a backwater prevention device must be inslalled on your <br /> sevrer connection to comply with the new ordinance. Please help us verify that our <br /> mformation is correct by answering the following q�estions about your propeAy: <br /> Do you have a basement? Yes � No ❑ <br /> If yes, does il have plumbing fixlures(sink, toilet, (loor drain, elc.)? Yes� No ❑ <br /> Do you have a backwaler valve on your sewer line? Yes ❑ No � Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes ❑ No [� Don't Know ❑ <br /> Name: —_�.�_ Q� ����e� -- -- <br /> Properly address: ._ �_S�__��-� ���� <br /> ''Phonel: �yS � ��QV�_13U�'`4ine2: _ "125 � � � -I � IYS�� <br /> [mail: �i��,fn/A �✓�� . 1�/���1�( 'r . ��� r�l`ril • 1��� ` \ <br /> , . • ,i — , .—*T;q <br /> : 1 , � <br /> . : ... .. . . r , .,� <br /> ._ � _ 1 .` . � • I � . . �. <br /> ! <br /> 3. ,:., . � � � ii_`.. l _.C!_ r.. _�._,....�... <br />