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_ "H <br />� � <br />BACKWATER PREVENTION DEVICE PROGRAM C� �� <br />. <br />ti `` � h <br />Our records indicate th�l a backwater pre'vention device must be instalied an yaur `` <br />sewer conneclion to comply vnlh ihe now ordinance Please help us verify Ihat our :� 1` j G <br />information is correct by aoS�ve[mg i,ie.Jo.11orving questions aboul your property: �� L � <br />� Q� <br />r...'.,� � v � � <br />Do you have a basement7 Yes•[�]' No•;� � �� <br />If yes, does it have plumbing FixlOres (sink, loilet, floor drain, etc )? Yes G� No ❑�� v J�. <br />Do you have a backwaler valve_on your sev�er line? Yes ❑ �o Q Don't Know [�J � <br />� r^ '� N <br />N- v d� <br />Do you have a grinder pump �n your basemenl� Yes ❑ No � Don't Kno�v � -' v� V <br />r <br />Name. <br />�l <br />�l,/ 1' <br />Propertyaddress: �7..�% �/1(� i•1( � , f%� <br />Phone 1:'! Z�l' �5���.. �/ d�!_ Phone 2: <br />Emiil _li�_�'1%1_4'i��'_1��'J—t-Zc�L . ( 0 �r1 <br />:il�.�a�.� ll�is�� �1, <br />�IUr�c; �' .,':._;'L <br />� <br />