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.. � � <br /> BACKWATER PREVENTION DEVICE'PROGRAM <br /> Ou�records indicate ihat abackwater prevenlion device musl be inslalled on your <br /> sewer connedion to compty .vik� the new ordinance Please help us verify that our <br /> in(ormation is correct by ansvrering the following questions about your property <br /> Do you have a basement7 Yes ,�Jo ❑ <br /> If yes, does it have plumbing fixtures (sink, toilet, iloor drain, etc.)? Yes No [,I <br /> Do you have a backwater valve on your sewer line? Yes ❑ No [�on'1 Know � <br /> Do you have a grinder pump in your basement? Yes ❑ No �}/Uon't Know ❑ <br /> �' Namc. �aW �EL I� l � �ON� � �1�1 ��� 1'�1 WiqNr . <br /> d <br /> Propertyaddress. ����7'rQ`'�W " Ve- <br /> Phonel: 'e2�• s�7' 1�2Z Phone2: �C��o � 7 ��� 242� <br /> Email. <br /> � �.._._...._.. � � � (1 i �� }��R��{'� . ` j���'�i:l� ) , �. <br /> ' - -- - ?t��iL��l�, tJ.l i'�f,+.�i,l�.l:i.h' L1L.r!� ��.:r..1;L•L•!�=.�:E <br />