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� <br /> � BACKWATER'PREI7E�V���Q_N;4EVICE PROGRAM <br /> ,�.• .,: .;: <br /> � �'�'. .'.Y:'�)..1 N <br /> Our records indicate Ihat a baCkwBter�ptevenlion device must 6e installed on your <br /> sewer connection lo comply'�!h tHe new crdinance. Please help us verify that our <br /> information is correct by ahs"Jeering ttle follovring questions about your property: <br /> ' Do you have a basement7 Yes � No ❑ <br /> If yes, does if have plumbing fixtures(sink, toilet, floor drain,etc.)? Yes � No ❑ <br /> Do you have a backwater valve on your sewer line7 Yes ❑ No ❑ Don't Know � <br /> Do you have a grinder pump in your basement? Yes ❑ No Q Don't Know�, <br /> Name: ��5�� <br /> Property address: �� 1 ��Y �� _. <br /> Phone 1:����IT I�3g Phone2: ��`351� ��� ' <br /> E�n,�� �1��`(sf-'��C��CC7MA[� .c.aM , <br /> -- �. <br /> .;.�� ����; , <br /> � ; ' I � i ! i �'� .� � , 1 , � <br /> �.;,.�..� .�.:..�...� � l .: ,, . ....�.:,�. . � <br />