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BACKWATER PREVEN"TION DEVICE PROGRAM <br /> Our records�ndicate that a backv�ater prevention dev�ce must �e installed on your <br /> se�ver cnnnection to comply with lhe new ordinance Plr,ase help us verdy thal our <br /> �rtormation is correct by anstvering the following quest�ons aboul your property <br /> Do you have a basemenl� Yes�; No ❑ <br /> If yes, does it have plumb�nc� fixluies (sink, totlet, (loor drain, efc )� Yes �j No � l, <br /> Do you have a backwaler valve on your sewer U�e� Ves ;-J No n Don'� Kno�v � <br /> Do you have a grinder pump in your basement� Yes ❑ No �on'I Know j .] <br /> Name . ���_��v �.�� -- -- <br /> 1'roperty address p��3 ,�L�v�L��� ��� _ <br /> Phone 1 Y�/���vS -�Z��JF'hone2 .lG✓��J'�Z �l.�/ 7 <br /> � .r ���� <br /> . /� <br /> Ema,l �!m_ ( ��/ l= /�t�'1� /�/J/h — <br /> — — __ .. . � — ---- --- _ <br /> � ' i � ���� <br /> – �--w - – --_-..�_.�...;.-_,S .1.� ' �. � �-- – I- . � !:..�. <br />