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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 lhe new ordinance. Please help us verify thai our <br /> informafion is correct by answering the following questions about your property: <br /> Do you have a basemenl? Yes �No ❑ <br /> If yes, does it have piumbing fixtures (sinl�, toilel, (loor drain,etc.)? Yes �No ❑ <br /> Do you have a backwaler valve on your sewer line? Yes ❑ No �Don't Know ❑ <br /> Do you have a grinder pump in your basemenl? Yes ❑ No �Don't Know ❑ <br /> Name: rR-1 7 1 CI- K I'�N7 0111 <br /> Property address: � I d"rJ [""�/L/� Iv �V� <br /> Phone���l �3��Q��� Phone 2•C�� �Zy�/��T <br /> Email: �� �,T� W1�1�I�I�7� •�v, <br /> �,I�'1 '' ���i:y e(�i,�1�•�• ,����� 1i+ L <br /> ��ii���'L,Il�llf�3r.�.'i l:l'���I�Ct��+t.<i�c`�l4l.Utf.�uC <br />