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� .. . ` y . . . . n � <br /> . . `.:. �'.. �.� R"f_. !.... . . <br /> BACKWATfR FK���/ENTION DEVICE PROGRAM <br /> ., . <br /> Our records indicate ihat a�backwaler prevention device must he installed on Ihe sewer <br /> connection at the address idenlified on Ihe enc�osed letter. Please help us verify ihat our <br /> information is correct by anserering the following 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.)9 Yes �[I No ❑ <br /> Do you have a backwaler valve on your sewer�ine? Yes ❑ No ❑ Don't Know� <br /> Do you have a grinder pump in your basement� Yes ❑ No � Don't Know �Q <br /> Name: C�IL•�Z�f�N <br /> PropeAy address: h�3 3� �1�+�+*�—� I J.2- . __ <br /> Phone1: 'TZS� 232���OA Phone?.: <br /> EmaiP CY n��S e r[ �4�0�- �ON'! <br /> . . _. ._ •._ ----- - . _ � <br /> � ...':r_' . <br />