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B�1C%{v��4TE� ��$E�%� -r'iQN ���s�E P�a{�'aR��n <br />Our records indicate that a backwater preuention device must be installed on fhe sewer <br />connection at the address identifiecf on the enclosed letter. Please help us verify that our <br />information is correct by answering the following questions about your praperty: <br />bo you have a basement? Yes � N� ❑ <br />If yes, does it have plurnbing fixtures (sink, tc�ifef, floor drain, etc.}? Yes No ❑ <br />Qa you have a back�rrater �a[ve on your sewer line? Yes ❑ Na �, Dan't Knaw ❑ <br />Da �ou have a grinder pump in your basement? Yes ❑ No � �on't Knaw ❑ <br />� <br />Name: � t ���"�`,*``�"`��` e�'�� � �,�������,�� <br />� � � ,.� ..�- <br />� ' � l �.����� f <br />Proper�y address: �-�' ,� �` ' <br />� ,. �,� , � p ��' �;'� x� '� � � ' "� <br />Phone 1: ��✓��� �c�..�� �� �� � Phone 2: � �° ��� °�;.� �,;.�'���� <br />�..::� <br />,�=_.� �-� <br />. .�' �. : . �+ ��` � ;,� �w � �;,�" ¢ <br />Email: �� $��'�°��,�:;�.���.�"����`.� �� ��`��� ���� �'������ ' ��� <br />� <br />