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,._. �r=t1't>� -'0�99 ��U- �37�a"►� � <br /> BACKWATER. PREVENTION DEVICE PROGRAM � <br /> ,�t ; � <br /> � ; . �., .: <br /> � Our records indicate preven,ion device must be installed on your <br /> � �+aG��backwater � <br /> sev�er connection t0`•�omply v✓ith lhe ne�v ordinance. Please help us verify ihat our <br /> � information is correct by answering the tollo�Nirg quesiions ahout your property: <br /> � <br /> Do you have a basemenl? Yes No ❑ \ 4 <br /> If yes, dces it have plumbing fixture (sink, oile (lccr drain tc.)? Yes Y No ❑ � <br /> Do you have a backwaler valve on your sewer line? Yes ❑ No [ Don'I Know�� � <br /> Do you have a grinder pump in your basemenl7 Yes ❑ No ❑ Don't Know�j.] <br /> Name: � �� J 1 C. I/C /1�S _—_ � <br /> Property address: � � � � __�' � � r _ <br /> (�J U IZ�-,!�� � <br /> Phone 1��5 -�S� ��'�� Phone 2: �o�Z�S� -�'G G 2]�� J � <br /> - /�J�L�+ C�1 L7.Qi1L ��Q.��� - � <br /> Email _ � '. <br /> : . , ., , , ; , ,� :� j . � , -�'! x <br /> '�"'.f�""`'�.."� . -. � . ;�� � _._:;, ��� _ �. 1 ��._� �,--'- - <br /> Su��aor! e�A'�e✓ ��on+ GftA�lt�erJ -- �lq2fl� Q <br />