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BACKWATER PREVENTION DEVICE PROGRAM <br />Our records indicate that a backwater prevention device must be installed on your <br />sewer connection to comply with the new ordinance. Please help us verify that our <br />information is correct by answering the following questions about your peoperty: <br />Dc you have abasement? 'Yes �KNo ❑ <br />If yes, does it have plumbing fixtures (sink, toilet, floor etc.)? Yes No ❑ <br />Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know <br />Do you ha%veeaa grinder pump in your basement? Yes ❑ No ["on't Know ❑ <br />Name: <br />Property address: l,IYn <br />5— <br />Phone L�� �7 D6 Phone 2: <br />Email: !.(r�C !�� C • Gb- _ __ <br />►�1,���,�i���tsitL;�:-:I.`;f;(:�.;.r,�`,� u' ��Li:�:1.;��.jl:�'tG_ <br />