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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backwatcr prevention device must be inslalled on your <br /> sewer conneclion to comply with the�ew ordinance. Please help us veri(y Ihal our <br /> information is correct by ans�vering the following questions about your property: <br /> Do you have a basement? Yes �o ❑ <br /> I(yes,does it have plum6ing fixtures sin tloor drai etc.)? Yes L No ❑ <br /> Do you have a backvreter valve on your sewer line7 Yes ❑ No ❑ Don't Know (� <br /> Do you have a grinder pump in your basement? Yes ❑ No � Don't Know [�� <br /> Name�.rf__,�.n .�l// /!/� – <br /> Propertyaddre��_��____���J� L.(J_._—vVG�p'���/ <br /> q / <br /> Ph�T'S ��� �� r '� Phone 2'�G� <br /> / <br /> FinaiC�i'p _ — � <br /> _ i; ,.,r:,�. � <br /> , � _� ��.—_ �---- --- - . .� .J � , '. _.. _ . - .�. ._- ' ' - =..'�'._ _.t�i I <br />