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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicale that a back�:�ater prevenlion device must be inslalled on your <br /> se.ver conneclion to comply�:�ith the new ordinance. Please help us verify that our <br /> informalion is correct by ansv�ering the follo�:�ing questions about your properiy. <br /> Do you have a basement? Yes � No ! <br /> If yes, does it have plumbing fixtures (sink, toilet, Ooor drain, etc.)? Yes � No ❑ <br /> Do you have a backwater valve on your sewer line7 Yes ❑ No ❑ Don't Know'� <br /> Do you have a grinder pump in your basement? Yes ❑ Nor� Don't Know ❑ <br /> Name: �(��.�__�C\�T 1 1�4 <br /> Property address: � Y� �ISJ ��c'� � �\�..k ��� <br /> Phane 1: � �I ,���_�.�_L�—j7}'hone 2 ���-vC ' <br /> i <br /> EmaiL -- --- -- — " � <br /> .. .i .._, . . _ ', t��-i l�,�`� <br /> � <br />