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�--- --- — <br />�• -k3ACKV`.'aTER PREVENTION DEVICE PROGRAGI <br />Ou� �ecords indicate that a �ack�•ia,ei p'.eventron dev'•.e must be . alled oo your <br />sev;er connechon lo comply.with ifie n$V�.;ord��r.ance. Please help �s venfy that our <br />�nformaGon is correcl by ansvienn'gih�;Tollowing queslions aboul your property: <br />Do you have a basement7 Yes y� No ,_^ <br />It yes, does it have plumbing fix�res (sink, toilet, floor drain, etc )"� Yes ❑ No ❑ <br />Dc ycu h2ve a back�vater valve on your sewer hne� Yes [' No Don't Know I�' <br />Do you have a gnndei pump in your b�semen;? Yes [) No Don't K�ow ❑ <br />Namc �� �i�— 1�� �_Y'1� � l �— <br />n1`� (� //�� i <br />F�roperty addiess 4�� __ v L��! p� �ti �`� l' — <br />F'honc 7 4!�� "_Zj� �4y6 � Phone 2--_- — <br />: �,,, � _ -- - - — - <br />- ,, . . <br />- �,— , � �,;r:,, ; ` , ��i � ; �I <br />.;:a,; ��,�.����►���:��.� ,���1���►:;���:�:,. -�,::�:�f���� o. <br />