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BACKWATER PREVENTION DEVICE PROGRAM <br />Our records indicate that a backwater prevention device must be installed on your <br />sewer connection to comply with the new ordinance. Please help us verify that our <br />information is corrr,cl by answering the following questions about your property: <br />Do you have a basement? Yes N No ❑ <br />If yes, does it have plumbing fixtures (sink, toilet, floor drain, etc.)? Yesl b No ❑ <br />Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know <br />Do you have a grinder pump in your basement? Yes ❑ No �(] Don't Know ❑ <br />Name: <br />Property address: 11� �jl L/�(��%u <br />Phone 1: `1-^ IOU 3 A Phone 2: <br />Email: C C ' \� ra r . IVyyw kf <br />