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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 correct by answering the following questions about your property: <br /> Do you have a basement? Yes E 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 Know <br /> Do you have a grinder pump in your basement? Yes ❑ No- j,DGGGGGGon't Know f]r <br /> Name:Property address: 1 113 1.Vet <br /> 5 Ave- <br /> cQ <br /> Phone 1: L /'7�Phone 2: <br /> Email: t.p5 q't IPi fYi C-ON <br /> Y } ` <br /> f <br /> _.. .7.4'4 <br />