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� <br /> BACKWATER PREVEN710N DEVICE PROGRAM <br /> Our records indicate that a backwater prevention device musl be installed 6n your <br /> sewer connection to eomply with the new ordinance. Please help us verify that our <br /> infarmation is cortect by answering the following questions about your property: <br /> Do you have a basement? Yes�No ❑ ' <br /> y1'O F1X�^¢S•✓ <br /> If yes, does it have plumbing fixtures(sink, toilet,floor drain, etc.)? Yes Q No� <br /> Do you have a backwater valve on your sewer line9 Yes � No�Oon't Know ❑ <br /> Do you have a grinder pump in your basement9 Yes 0 No�Don't Know ❑ <br /> Name: /�iC���^-^'` /am i i� i c�...� �Ca ��E' _ <br /> Properlyaddress: �y� � �Tt—o�r� A-tr¢/�UQ EU2.�"�� �0 �� <br /> Phone 1:C ZS) 4 Z2 g�-�� Phone 2: �VI�l�.�,y._¢.�p <br /> Email: � �<- �� ( - <br /> , i. .�. � � �1 .' . <br /> - _ �. .� ..�...�.�—.. .� <br /> ' � ._....�J,a 'S-- �`.... � � —_J:._ .. . . _ J '.�._ �1 <br />