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BACKWATER PREVENTION CEVICE PROGRAM <br />Our records indicate lhat a hackwaier prevenlion device must be insta0ed on your <br />sewer conneclion to comply wdh the new ordinance. Please help us veri(y thal our <br />intorma�wn is correc� by anstivering Ihe following questions aboul your property <br />Do you have a basemenl? Yes /�No ❑ <br />I( yes, daes it have plumbing fxtures (sink, t�jc�(loor drain, etc.)? Yes �o �_] <br />.� � <br />Do you have a backwaler valve on your sevaer line? Yes [] No U Don't Know I <br />Do you have a grinder pump in your I�asemeN? Yes ❑ No ❑ Don't Know �� <br />Name _� _ �CJ� - /► --- <br />Properly address: o��� �J (p ✓ //i C ��v�I�Y_7_l�� <br />Phone 1' �.�.5 —'%-� 5 0 Phone 2' -- -- <br />f_mail — <br />__. _..._ _ � <br />_ 1. <br />