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BACKWATEI= PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backwater prevention device musl be installed on your <br /> se�vei connection to comply vnth the new ordinance. Please help us verify that our <br /> inlormation is correct 6y ans�vering the following questions about your property: <br /> C`� you have a basement? Yes� No ❑ <br /> If yes, does it have plumbing fixtures (sink, toilet, floor drain, rlc )? Yes �_ No ❑ <br /> Do you have a trackwater valve on your sewer line? Ycs ❑ No ❑ Don't Knova � <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know� <br /> Name r ''� ���` <br /> Proper/tyr a/ddress: ����Q�—�.�il� -- <br /> Phone 1``���"�'b� U� Phone 2 __ <br /> [mail. ��-►`- � _�"�'�1 �_ Li C9 � • (`_�,^.—.._� <br /> ♦,+. Y ' • <br /> ' '•! �, .._�. ., � � .k ■ <br /> .J:� I�.t ��l ..� .• J . . ...�. . . . . • <br />