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; ,;w, BACKWATER PREVENTION DEVICE PROGRAM <br />,=,;;; , ,. <br />.,.�.�... <br />�; Ouc rocords indicate thaPa backwater prevenLon device must be inslalled on your <br />!,! se�cer connection to comply vnlh the nee� ordmance Piease help us veri(y ihat our <br />;"in(ormalion is totrect by ans�vering fhe (ollo�ving questions atioul ynur property <br />Do you have a basement? Yes�No ❑ <br />I( ycs, does d have plumbing fixtures (sink, toilet, (Isnr dra�n, etc )� Yes � No ❑ <br />Do you have a backwaler valve on your sev�er line? Yes ❑ Nn ❑ Don't Kno�a� <br />Uo you havc a gnnder p�mp in your basement? Yes � No ❑ Don'f Knuw � <br />i /� <br />Name -- - -(( Q _ . �. - , �_ic�_—__ �-n� - — <br />Properly address. _ _ �'_ _� �� 1 ✓ / J_�_l� ` v� - <br />Phcnc 1 C�^(��_�LJI �—V_7_J Phone�-C.��_.� L�'_ J�� � � <br />��,,,�r <br />r��'� ��l��sz � _5�►� �-f���'� �rm � '�, <br />- - '' +-----;.-_:-�, `I,�1i�`U��' �(�������o.Gt!��l' `' �—;---� . <br />r---- � ;6`��@-.i$:L��'.d��J��:�.�: +7.1,��1:`�Ll�'SLii:l'L!:���i, �:'31.21l�:•'t.L�� o� <br />