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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/No ❑ <br /> If yes,does it have plumbing fixtures telPoilet,floor drain,etc.)? YesJ'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 ❑ 1 LI No Know <br /> Name: C�i:, ,pCL (1r5clin <br /> Property address: 1 7 2 v 2 LA k L t <br /> Phone1: 4z-s ZS I Zg2s" Phone2: 4-r?c 30$ -,l l q-F/ <br /> Email: Ce Q-Y 5t5r) 1MS V1 e [.otvl <br /> qq <br />