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I <br /> 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(sink,toilet,floor drain,etc.)? Yes 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 ❑ No,❑ Don't Know <br /> q 4; <br /> Name: t �ec,:� <br /> Property address: - vtL f EVetr LA/A <br /> Phone 1: `C 3'� Phone 2: <br /> Email: tAtA tt 1 G1 \f edi OD CA:r+'1 <br />