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,. r . <br /> , r,. . , / <br /> .. ��,\ • � .�1�:���'_ <br /> � " � BACKWATER PREVENTION b��CCE-PROGRAM <br /> Our records indicale that a backwaler prevention device must be inslalled on your <br /> sewer connection to comply with the ew ordinance. Please help us Oerify that our <br /> information is correct by answe�ing i e folloe+ing questions about your property: <br /> Do you have a basement? Yes No [' <br /> If yes, does it have plumbing fxlures(sink, toilel, floor drain, etc.)? Yes � No ❑ <br /> Do you have a back�vater valve on your sevaer line? Yes ❑ No ❑ Don't Kno�v � <br /> Do you have a grinder pump in your basemenl? Yes ❑ No �Don't Kno�v ❑ <br /> Name. '�} { .� ! /�� •�.'..--' <br /> Prope�ty address: �/ //7�i F—Vl � j�'` <br /> Phone _ 9 A�� � hone 2: . . . <br /> � <br /> Email: �� � 7. 'Y�� 1' �',�'v' /�Y�.��d=� ' <br /> -- • - �. .,���,rl�\�g��� �f ��t �iF:t. .� � <br /> � <br /> - - •- -- -; :�1.I�ildl�l�,1.�,•;11I:��t�ls�ul��r,«�,!;, ���-�,�::,.1;s.F.� <br />