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� ;,� <br />- BACKWATER PREVENTION I�EVICE FROGRAM <br />` . Our records indicale that a backvfater prevention device must be installed en your <br />se�ver connedion.to comply w�th the ne�v ordina�ce. P,lease help us venfy that our <br />information is correct,by answering lhe follo�vina questiors ahout your property: <br />Go you have a basemenl7 Yes_,� No � �� <br />If yes, does it have plumbing fixWres (sink, toilet, floor drain, etc )� Yes�No � <br />Do you have a backwater vaive on your sewer line? Yes ❑ No ❑ Don't Know � <br />Do you have a grinder pump in your basement? Yes ❑ No ❑ Don'i Knoe� �" <br />Name: (/L1.4'r' N f //�_�'LI�. f� ��G�� C�e. 1 1 <br />Property address. _/ (� <br />Phone 1�Q 6��' j 7 G Z= Phone 2. �Z�' Z ��'� ((� <br />Emad �1Q V'�'y ►rq(.Ke.�0.4 �• GO�vL _ _ <br />( <br />�'q?,,in �.�'�.. — <br />— � — :.;,i.��l� L��.I�:�.�`;s�.i�c:�::�l�� ��; ..._1l� _i��:::t..e.� . <br />