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BACKWATER PREVENTI�N DEVICE PRUGRAM <br />Our records indicate that a backv,aler prevention device must be installed on your <br />seeder connection to compty vdilh the new ordinance. Biease help us verify thal our <br />information is wrrect by ansv;ering the following questions ahout your property: <br />Do you have a basemenl? Yes�No ❑ <br />If yes, does it have plumbing fixtures (sink, toilet, floor drain, etc )? Yes�o [] <br />Do you have a backv✓ater valve on your sewer Iine2 Yes ❑ No �Don't Knov✓ ❑ <br />Do you have a grinder pump in your basement? Yes � No �Don't Know ❑ <br />Name' Y-Q•Vl1 U�K.�(i"5�' cJ1i lA Qi VV �W� <br />Properry address: � �� ��t nl�� <br />Phone 1: � Z+j ����� Phone 2: <br />��,:�„� �/Q,t-t�uit�lS�t_�(�vrtCc�9t <br />�p i.�.il .�,� i i <br />—OZyZ <br />, �,3i',i�.. . <br />�S�!' f �.� -_L��'�,:�;,lt �.I: �� <br />r <br />