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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backwater prevention device must be inslalled on your <br /> sewer connection to compty wilh �he new ordinance. Please help us verify that our <br /> information is correcl by answering ihe tollowing quesiions about your property: <br /> Do you have a basement? Yes� No � <br /> I(yes, does it have plumbing fixlures (sink, loilet, iloor drain, etc.)? Yes j�No ❑ <br /> (V <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don'f Know� <br /> Do you have a grinder pump in your basement? Yes � No y� Don't Know � <br /> � /� ' <br /> Name:���(�� _ � — 1 ��V�'� <br /> Properiy address: �b�_�,L_� r ��1�Q e' G���-'�'1 <br /> t Phone 1: ���5��_L.]1 Phone 2: <br /> [mail: ��Q_CL+r-�e�\e,JJ—������1.�W 1m <br /> --- , ,�vi`�� -- ;�,: . �'�'�„'s" <br /> �'�} tI � <br /> L ...:'..�id ��� ..J:..!� . . . . .... ��lk .M��1'_ � . . .... 1 C_ i.�b.J��� <br />