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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate ihat a backwaler prevention device must be inslalled on�he sewer <br /> conneclion at ihe address iden;ified on the enclosed leder. Piease help us verify that our <br /> mformation is correct by ans�vering the following questions about your property: <br /> Do you have a basement7 Yes �o ❑ <br /> If yes, does it have plumbing fixtures (sink, toilet, floor drain, etc )� Yes �o ❑ <br /> Do you have a backwater vaive on your sewer line? Yes ❑ No ❑ Don't Know � <br /> Do you have a grinder pump in your basement? Yes � No �Oon't Know ❑ <br /> Name: � G�aC�_�({S�� C-� <br /> Property address _�!_ W �� {�✓�Q� A-�l`p• <br /> ' Phone 1: ���(p� Phone 2: <br /> —.� ' �a��—_�'—��—_� <br /> [maiC �C 7G( �Qf i 0' �al -(t�N( <br /> — :.;'����i Vi` — o�— . , .I . .,, tli. . <br /> . I <br /> _,=:Itiilt..>�_.� ..il `_ " .. _��1 . � ..�-._ ,. ._. .�.__1{� _ �'1 ' . .. _���i „� c�_ ■ <br />