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BACKWATER PREVENTION DEVICE PROGRAM <br />Ou; records indicale that a backwater prcvention device must be mslalled on your <br />sewer connec�ion to comply with lhe ne�v ordinance. Please help us verify tha; our <br />intormation is cortect by answering the following queslions about your pioperty <br />Do you hav= a basement7 Yes �I No ❑ <br />If yes, does d have plumbing fxlures (sink, toilet, (loor drain, etc )� Yes [ki No ❑ <br />Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Dan't Know [.FJ' <br />Do you have a grinder pump in your basement7 'Ies ❑ No�� Don't Know ❑ <br />Name �� 5% �— (� U. 5C (f a., i-�"7�_ <br />Property address �j� ( 7 � 1Qw�r5 (� t� /i ✓r <br />Phonet ��1��- �5���-Jt;�l1- Phone2 <br />EmaiC �ri <br />;: �� .,� <br />1I1\ i. <br />��I���L� JO1�` `.'... <br />� � 1 <br />', . f � I •i <br />_ �....�. .r_. .._.�+Y�I.�:: <br />