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1 gg }i <br /> Y• <br /> .'$1 Z4. <br /> G:. <br /> BACKWATER"PREVENTION'OEVICE PROGRAM <br /> • Our records indicate that a backwater prevention device must be installed on your <br /> sewer connection to comply with the new ordinance.Please help us verify that our <br /> information is correct by answering the following questions about your property: <br /> Do you have a basement? Yes [' No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes K] No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know X <br /> Do you have a grinder pump in your basement? Yes ❑ No X Don't Know ❑ <br /> Name: 'a�$I,'� S�Nki,•J-s <br /> Property address: 523 G R-AJ /_\Ve a EvegeTt, f v,1 fl 1 <br /> z06- b 0,7-}'04.t <br /> Phone 1: Liss`����3655 Phone 2: t <br /> Email: MA A L I-T'7(4Y(,t C . cc M <br />