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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 property: <br /> Do you have a basement? Yes rk.11o ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes No l <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? <br /> Yes ❑ No ❑ Don't Know <br /> Name: ch n 5 SeiroL. <br /> Property address: oS r✓veref4-elf✓+► '• zof <br /> Phone 6206)412(....)41 Vet Phone 2: 00 O ?((( <br /> Email: v(e..„( de O Leat�t(,�''•�ddG-jam <br /> ,IL` <br />