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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records ind�cate lhat a backvdater preveNion device must be installed on your <br /> se�ver connection to comply wifh the new ordmance. Please help us venfy that our <br /> informalion is correct by answering the followiny yuestions about your property <br /> Do you have a basement? Yes ❑ No ❑ <br /> If yes, does it have plumbing fixtures(smk, toilet, floor drain,etc.)? Yes 0 No ❑ <br /> Do you have a hackwafer valve on your sewer line? Yes ❑ No ❑ Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes �] No ❑ Dori t Know ❑ <br /> Name: �-� � l�l�� /�-8'-cx�� <br /> '_�� <br /> P opert�ddress: i7a3���(.� ��' <br /> / <br /> Phone 1 � Phone 2. - <br /> 7 <br /> Email. -- ------ <br /> !�- — ----� .—���,� =�I�s���� i��;���'`c;a�i'i�k�:4'�,��.���,..�;,;,�,:�::ct:� �.i <br />