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n <br />BACKWATER PREVENTION DEVICE PROGRAM <br />Our records indicate that a backwater prevention device must be instalied on your <br />sewer connection to comply wilh the new ordinance. Please help �s verify ihat our <br />information is correct by answering the (ollowing questions about your property: <br />Do you have a baseme:nl? Yes�No ❑ <br />I( yes, does it have plumbin3 tixlures (sink, foilet, Ooor d�ain, elc.)7 Yes �No � <br />Do you have a backwater valve on your sewer line7 Yes ❑ No �j Don't Know ❑ <br />Do you have a grinder pump fn your basement7 Yes ❑ No� Don't Know ❑ <br />Name: <br />Property address: <br />Phone t: liQ�i �y 9�,3�` __ Phone 2: ________ ____ <br />Email: _ GI.I< � �i�'� C7R �_yGLn_c3�_(Q%�'!_ _— <br />�.-�I'•�1�1I �� f� �r t� '���.. . .. <br />�_.1�f:�:n:1;1UiL�.�'•!��'�1,�.i�:i.'L"l1�".�t.?'.S; a` <br />:�'uw�x �._�� :e�.:,.:�� i ' "'�`� r_�� � . ��� # ? `s'. - -- <br />