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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records mdicate that a backwater prevention device must be installed on your <br /> sewer connection to comply with the new ordinance. Please help us venfy thal our <br /> information is correcl by answering the following questions aboul your property: <br /> Do you have a basement7 Yes�No n <br /> If yes, does it have plumbing fixtures(sink, tailet, Ooor drain, etc.)? Yes�No (J <br /> Do you have a backwater vaive on your sewer line? Ycs ❑ No �,Dor.'t Know ❑ <br /> Do you have a grinder pump in your basement? Yes �� No � Don't Know [J <br /> Name: J A. /''!,,�c L�o� _ <br /> Property address: ��_/�r_CK�R- �✓��--- <br /> Phone 1: y�J!_��/_.Q�Phone 2: _ ____ _ <br /> Email'. _ 1 Y✓� �C.0 `� �3O��ma� I , eovv� _. _ <br /> � <br /> ..r:�: � � .S. '�' ' � � . <br /> "'`��'-''�_ __ �. � � � , . . _�..__�� ...�.. ._._ <br /> :.?_:.: � :1•. <br /> 'H �:.�� � _3 1 .�:1...��_�I� �'.�!�__ .� . 1. . � .. <br />