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� / <br />� BACKWATER Pf2�'JENTION DEVICE PROGRAM <br />Our records ind;cale lhet a backv!ater ptcvention device musl be.installed on ihe se:+er <br />conneclion at the address identified on the enclosed letter Piease help us venfy Ihat ou� <br />information is correct by ans�•+ering the follov+ing questions aboul your property <br />Do you havc a basement7 Yes I� No ❑ <br />If yes, does il have plumbiny fixtures (sink, todet, floor drain, etc )7 Ycs f�j No �_] <br />Do you have a bach�vater valve on your sewer line? Yes ❑ No [� Don't Know ❑ <br />� <br />Do you have a 3:i�der pump in your basement� Yes ❑ No ❑ Uon'1 Know �[ <br />N�me: W( I L(� �� ` l31'�- . _1��C.1�'1.Q.1� ��/L- _ <br />�r � �I �- � l.� C fC_P1L. <br />Property address _ ___._ <br />�U�'G�� �� b Phone2: _��� ../" �I �I�-' <br />Phone '. �- �L <br />fmail — — -��i �l � L'—S v _ �U rn�a.S�� �1..Q�1 <br />i. ' {�jf'- �� 1+ <br />1���ll�L��� '�_�2ill I1.�.��'.a���_ � r''L�}�li�'.''!�1'`t1�/:��i.hiQJ � <br />