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BACKWATER PREVENTION DEVICE PROGRAM <br />Our records indicate that a backwater prevenlion device must be installed on your <br />sewer connection to comply with the new ordinancc. Please help us verify ihat our <br />iniormalion is correct by answering the follovnng questions about your property: <br />Do you have a basement7 Yes �No ❑ <br />I( yes, does it have plumbing fixtures (sink, toilet, floor drain, elc.)7 Yes � No ❑ <br />Do you have a backvrater valve on your sewer line? Yes [ No Don't Knov� � <br />Do you have a grinder pump in your basement7 Yes Q No ' Don't Knoer i� <br />Name: __���_ � ��I�'�-�C" <br />Property address ��_ .1_���i%l �V� w� C1 �"�' <br />Phane t:C�` Z�' �`� Phone 2: _ <br />Email: _ _ W_��115 �—�—��Q . Cd �'�'1 <br />J���:!_�.,:��.ii.J..��'_'.. ���`_..ia_i:._ • <br />' ._....�. . .:� <br />�:�' <br />jtCr, <br />r.. . �-:r*Cc'a-. �-. ..x " �. .c � S. � < - -v vi �} y� "_ <br />•..n„_�._ �_ R?.i:'.i}W65MmWV..�*.., ..:+J',.ffiKS' e�Y`' s.. � ft'.r'�,�::���'.�� 3i'�� i6t�'_".4�:-.Y��,. <br />