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BACKWATER PREVEN710N DEVICE PROGRAM <br /> Our records indicate that a back�vater prevention device must be mslalled on your <br /> sewer connec;ion ro comply�vith lhe new ordinance: Please help us venty that our <br /> in'ormahon is correct by ans�vering the (ollovnng questions about your property <br /> Do you have a basement? Yes �o ❑ <br /> If yes, does it have plumbing fixtures (sink, toilel, floor drain, etc.)7 Yes �o ❑ <br /> Do you have a backv+ater valve on your se�ver line? Yes ❑ No ❑ Don't Know � <br /> f?o you have a grinder pump in your basement� Yes ❑ No Q Don't Kno�v ❑ <br /> ,.✓'` <br /> Name ,���1—�C�-�?�_/-�� <br /> Property address I_ �Z _�i`L-��,e� ��� <br /> Phone �-v��_I_(�1��� Phone 2,�1(_�t���(� <br /> `�`� <br /> Email 'V�-}����-�'�- ma�l:_oy_u <br /> _ _--- „��� �:.� ' � I l�►i►"���'�!�� ,.,��r4':� �i : �,: <br /> . ;i1�1F ,t u �.in:..:,.:., Y� l:ji'�'�;L�, :��..i�:1.�,� E,� <br />