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BACKWATER PREVENTION DEVICE PROGRAM <br />Our records mdicale that a backwater prevention device must he installed on the se�.ver <br />connection at the address idenlified on lhe enclosed letter. Please help us verify that our <br />information is correcl by answering the (ollowing questions about your proper+y. <br />Do you have a basement? Yes� No ❑ <br />If yes, does it have plumbing tixtures (sink, toiiet, floor dram, etc )7 Yes � Na ❑ <br />Do you have a backwater valve on your sec:er line? Yes ❑ No ❑ Don't Know � <br />Do you have a grinder pump in your basemenl? Yes � No ❑ Don't Knotv � <br />Name: --A ILi i�C ( <br />i <br />Prcperty address: ..__� <br />��� �� <br />Phane 1 _�,,, <br />Email: �1f,sY <br />10 � <br />� <br />� �-'� -�-1� <br />l%--' --""—a-- <br />�—�'-�-��e2 — ��i� ��3--! � 2�1 1 Y� <br />S.�_ Q� ��J_1_L1 _.�.�-iJ'V_i.� r�".� ._(%Q v'V � <br />�3��i,�=d��L+:i��.�.�:t�Wi;� i 1�1�'3��..�.:ti�L'l:f.bt�. �`� <br />,•���•V <br />