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t � <br /> , / <br /> BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backwater prevenlion device musl be installed on your <br /> sewer connection lo comply with the new ordinance. Please help us verify tha�our <br /> in(ormation is correct by answering the following questions about your property: <br /> Do you have a basemenl? Yes �} No ❑ <br /> If yes, does it have plumbing fixtures (sink, loilet,floor drain, etc.)? Yes � No� <br /> Do you have a backwater valve on your sewer line? Yes Q No � Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes 0 No � Don't Know ❑ <br /> Name: �C��J�I 4/�u��� ^ <br /> Propertyaddress: l VO`�y WGI! "•0�+ A�G ��0�4 (. <br /> �' Phone 1: J� 7V Phone 2: d'S' ���� <br /> Emai�: ��%/1 a�G YfCJC�_ r�v7 <br /> ��t•�i�,b�l4��i:�'�e��'�'L41����s.:��=�ir�t:��.�;� <br />