Laserfiche WebLink
�:;�:. � � � : i.: <br />�, <br />BACKWATERck?.f+iEVEiYTION DEVICE PROGRAM <br />;r.:,; :�t=F °3.tj <br />Our records�,Lnd'`c�tP �hal a bar.ke✓ater pmvenlion device must be installed on your <br />sewer connc�titidn t� cromply with the new ordinance. Please help us verify thal our <br />intormalion is correcl by answering the following ques�ions about your property. <br />Do you have a basement7 Yes � No ❑ <br />If yes, does it have plumbing fixtures (sink, toilet, floor drain, elc.)? 'fes �No ❑ <br />Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know� <br />Do you h ve a grinder pump /in� your b/asement? Yes � No ❑ Don't Knowx� <br />Name: `���I�� 1\ �� �`� l� Ci -- <br />Property address: ���� V ������ 1 1��\ ,\"�v <br />P h o n e 1: f� r J< �� �C I L P h o n e 2� I � J �� ���� L/ <br />Email. <br />� <br />,. t i —^ — t I, �Y,�� . <br />_,!4'__ '-2 . . _._'. .. '3�. �.r�S ._.�, .., __... . . _ .... .. � I._ ..._ _,. m� <br />