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. - -- --- i <br /> ' lBACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indica�e thal a backwater prevention device musi be installed on your I <br /> sea�er conrec;io� tc comply with the new ordinance Please help us venfy lhat our <br /> in'ormation is correci by answeriny the following questions about your property <br /> Do you have a Lasement? Yes � No ❑ <br /> If yes, does it have plumbing fixiures (sink, toilet, floor drain, etc )? Yes�� No ❑ <br /> Do you have a back�valer valve on your sewer line? Yes ❑ No ❑ Don't Knoav � <br /> Do you have a grinder pump in yo�r basement7 Yes ❑ No I}� Oon'1 Know [] <br /> Name: �aI- � �J _ � �-A't7W� G �C _—. -- -- _ <br /> Property address �� 1� � u C ��P /� �C _ _ _ _ _ <br /> Phone ? �I2 5�3�l � lZ � Phone 2 �'I Z-�__�7 7 C1 �Z S w��f <br /> Entail _�O �- I� {�. � �r(�Q h� . Jl-Z. - — <br /> ��� � �'�':. '�'S;71�'��� Y�rT i �i'7�• � . . <br /> .� �.»�:yl�#�4��l��.�:1;,4�1��� I.�l��i���I,�:,�:F-����t��bU�:� m. <br /> <; <br />