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---- --- _ . <br /> BACKWATER PREVENTION DEVICE PROG�AM <br /> Our records indicate that a backv�ater prevention device must be installed on your <br /> sewer conneclion to comply with the new oroinance, Please help us veri(y lhat our . <br /> information is correcl by ans�•:ering Ihe follovding questions about your properly: <br /> Do you'have a 6asemenl? Yes.(��No ❑ <br /> If yes, does it have plumbing fxtures (sink, toilet, floor drain, etc.)7 Yes�No ❑ <br /> Do you have a backwaler valve on your sewer line9 Yes ❑ No�Don't Know� <br /> Do you have a grinder pump in,your basement? Yes ❑ No IM Don't Know ❑ <br /> 1�\ <br /> Name: �'O S � .J�n� s o N <br /> Property address �J �� �/ vV �i � �Il� �� <br /> Phonc 1. ��`5"as Y-��-��9 Phone 2: <br /> Emaii � Lr /'1 1. C '-Is��� - l.� ---- — <br /> . i � .r��l! 7f h�+� t �,�t r •� : <br /> � �., � , S��i�i1 ' �4� <br /> _ — _ - ;--_—�'' :�'�.1�+f3�e.i�}�?��1��1,� . ��z1`;�Slll�dfl��� ;�I,��:t}�t1:�l���.t,� , <br />