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Y10 C Xfm,/Lf /A- , 10 4 k6,1,L U/ vL.ai (-.t.c_ <br />BACKWATER PREVENTION DEVICE PROGRAM <br />Our records indicate that a backwater prevention deyjce. must be installed on.yonr <br />sewer connection to comply with the new ordinance. Please help us verify that oui <br />information is correct by answering the following questions about your property: ' <br />Do you have a basement? Yes J<No ❑ <br />If yes, does it have plumbing fixtures (sink, toilet, floor drain, etc.)? Yes J�(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 />Name: 't G [� 7�✓/1 jr C r'� <br />Property address: <br />} Phone 1: `(� � Cl0—� 0 Phone 2. <br />Email <br />i <br />1 � <br />AL_I"Lg c�`L� It_i <br />