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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backwater prevention device musl be installed on your <br /> sewer connection to comply�vith the new ordinance. Flease help us verify thal our <br /> intormation is correct by answering the follov:�ng questions about your property: <br /> Do you have a basement7 Yes �7q No ❑ <br /> 7� <br /> I(yes, does it have plumbing fixtures(sink, toilet,lloor drain,etc )7 Yes�(No ❑ � <br /> / ` <br /> Do you have a baokwater valve on your sewer line? Yes [ No � Don't Know� <br /> Do you have a grinder pump in your basement7 Yes [ No � Don't Know��\\� <br /> _�` <br /> Name: —��- '�L1/�-W�-�-i Z 'ti'-�- ``��r,0 <br /> :: r <br /> Propertyaddress: �_�Q��_� �e <br /> Phone � y��=_J_( Q� Phone 2: �{3-5 ��_Z � u y� <br /> Email: _�f'tv y_�_�1-(�Z�j'�_� �r�tS.1T�Y�— <br /> f � : ' •, �� , ,�, <br /> . , • , <br /> _ __ _.�:._ '�'j. ..� _ � � ' t ` �., . . .... <br /> �'. ���: _' � •z1: _il.'_ ..1 i...�ti ����..�....�, f� _ . . _ li I <br />