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BACKWATER PREVENT19N DEVICE PROGRAM <br /> Our records indicate that a backwateq'prevention device must be installed on your <br /> sewer connection to comply with the r'rew: fdinance. Please help us verify that our <br /> information is correct by answering(he4pllowing questions about your property: <br /> Do you have a basement? Yes IA No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes'`,, No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don'``t Knowc4" <br /> Do you have a grinder pump in your basement? Yes ❑ No)Don't Know ❑ <br /> Name: S i� (/f/lr/S' <br /> Property address: /l a <br /> Phone 1 F9oj6—'o75-c2—3 G- Phone 2: <br /> Email: $l/S�l'yt'X/eie t/ C� '17 <br /> �.,..aw, `t.z i 4i ., T <br />