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BACKWATER PREVENTIOtd DEVICE PROGRAM <br />Our records indicate that a backwater prevention device must be installed on your <br />sewzr connection to comply with Ihe new ordinance. Please help us verify that o�,. <br />information is correct by answering the follov✓ing questions ahout your property: <br />Do you have a basement? Yes `� No ❑ <br />iF yes, does it have plumbing fixtures (sink, to�!et, floor drin, elc.)? Yes;�J No ❑ <br />Do you have a backwater valve on your sewer line? Yes 0 No ❑ Don't Know � <br />Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know'� <br />Name: <br />Property address: � 4( Q �]�7'Fl ST _ <br />� Phone 1: �1�� 2g� 3-4� Phone 2: �P'P ���1 � 3� �!'/ <br />Email: .K� ��YI 6:o v,c,-IP��I iGW�'� �! GG l -- <br />1 <br />� .. � .. -'��� 1!i;.i,�,'..3 � .e„y,., .. . <br />_ i, . '� , . �' ,. r�. <br />� � � � 1 .. ,i: <br />---1�--��� � . '•J �.: •-- -.. . ...�__sll .. ._.�, . . ��1:�,. ; t�i. <br />