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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate ihat a backwater prevention device must be inslalled on your <br /> sewer conneclion to comply with the new ordinance. Please heip us verify that our <br /> information is correct by answcring the following questions about your property: <br /> Do you have a basement7 Yes � No � <br /> �Q�-TC. �'`� )'U�ii� ""��{ <br /> If yes, does it have plumbing fixtures(sink, toilet, iloor drain, elc.)? 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 '1,/" Oon't Know� <br /> Name: _U" W� �� �/ v� /7 /v -] Q I Y <br /> Prnp� ay ddress' 1�_I_7���/1Q_R� A V� <br /> �� '�O�'� <br /> Phonel: yZ�— l -�y7 Phone2: <br /> [mail: "`—�— <br /> — . • — •��; '�I. .i�'�' '� .;';' r . <br /> -- ------- . � ------ .L ..'. .. _. i�:;.�.�:il.t�•� :, � i'��.�..-' -I� --..�:�i . . . .�.'�J�.�_.,._ l�_ ■ <br />