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BACKWATER PREVENTIO,N DEVICE PROGRAM <br /> Our records indicate Ihat a back�vater prevention device must be inslalled on your <br /> sewer connection to comply with Ihe new ordinance. Please help us veriiy that our <br /> information is correcl by answering the follotving questions about your property: <br /> Do you have a basement? Yes [� No ❑ <br /> If yes,does it have plumbing fixtures (sink, loi�el, floor drain, elc.)7 Yes� No � <br /> Do you have a backwaler valve on your sewer line? Yes���Don't Know ❑ <br /> Do you have a grinder pump in your basement7 Yes � No �Don't Know ❑ <br /> c-� � <br /> Name: ' �• �"�Y � <br /> Pro rty ress: �_�-_(�' —� � _.__— <br /> Pholl� 1y��� 7 Z Phone 2. _ _-- <br /> Finail _ <br /> , . , � ;:�� - � ,�, <br /> i ' �, ` ' � y� �.. : <br /> ---- - - _L.' -- i. � _ , '- , ._ . . _. . . � . . .. ... . , <br />