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� <br /> . � <br /> � BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a bac4cwater prevention device must be inslalled on your <br /> sewer conneclion to comply wilh the new ordinance. Please heip us verify that our <br /> information is correct by answering the following questions aboul your property: <br /> Do you have a basement7 Yes�( No ❑ <br /> If yes, does it have plumbing fixtures (sink, toilet, Floor drain, etc.)? Yes� No ❑ <br /> Do you have a 6ackwater valve on your sewer line7 Yes ❑ No ❑ Don't Know� <br /> Do you have a grinder pump in your basement? Yes ❑ No�Don't Knotiv ❑ <br /> Name: �Q ���-LETT� <br /> Property address: I I �L � �SR� � �V £ <br /> Phone 1: 42�.33q. y �0 a Phone 2: <br /> EmaiL' _ <br /> _ <br /> . _ �_... � <br />