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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate Ihat a backwater prevention device must be installed on your <br /> sewer connection to comply with the new ordinance. Please help'us verify ihat 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 plumhing fiMures (sink, toilet, oor drain etc.)? Yes,'�No ❑ <br /> Do you have a backwater valve on you�sewer line? Yes ❑ No ❑ Don't Know�' <br /> Do you have a grinder pump in your basement? Yes ❑ No� Don'� Know ❑ <br /> Name. �"/� "'"� " eJ <br /> 1�l� wc,l�.e✓ -� -�— -�-. .. ..��- , <br /> Propertyaddress: ,) � '� : ' ' ` '�'�Y <br /> i:: •\lr.Dnnatd tYt�tcy� �,� �': .� <br /> ,I� �� I�� ��IHIS RiicAcr Avc. ..� , ;. <br /> Phone 1: �f Phone 2: � F.vcnn:lvn9sioi � ;.i i...�u� � <br /> - '� _. .�..,... ..��. _s::_.. <br /> Email: �/'7r <br /> , � , �.. <br /> • -- —�- . . =- :.�_'_,s _:�_ '.� ' " ....__.:__1_:. :� . . ..l:..L� � <br /> I <br />