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8,4GKWATER PREVENTION DEVICE PROGRAM <br />reFords indicate ihat a back�vater prevenfion device mus: be installed on ycur <br />�r connection to comply vnth the ne�v ordinance Please help us verify lha' eu� <br />rmation is correct by answering the following ques�ions abou' your property <br />Do you have a basement7 Yes � No ❑ <br />If yes, does it have plumbing iixtures (sink, toi et, floor dra�n, elc )� Yes �' No ❑ <br />Do you have a backv+ater valve on your sev�er line'% Yes ❑ No U Don't Knoc,� 1,�' <br />Do you have a grinder pump in your basement� Yes [� No � Don'! Know � <br />� <br />Name �l,tL1�_��J,^!,^1 <br />PrnnPrtv addfPss� /� � � l� ��`� � �. <br />V� � <br />Phone L �I �`) �JU�_ �✓____ Phone 2 <br />Em2il�. �C��C'}"_�� � � ��. `- a�..—'�l)L , �ii.'� <br />',:ei.3rt:_ .. . <br />"'`��__�."'�' _ _._.._�.. ___ <br />, a... . <br />�� <br />