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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a!.)ackwaer 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 alswering the following questions about your property: <br /> Do you have a basement? Yes ❑ No ❑ <br /> If yes,does it have pluObing fixtures(sink,toilet,floor drain,etc.)? Yes ❑ No ❑ <br /> ��fii� <br /> Do you have a backwater valve on your sewer line? Yes ❑ No III Don't Know ' do <br /> Do you have a gripder clump in your basement? Yes ❑ No ❑ Don't't Know <br /> Name: \Q C)\ -Uerct \v-itA��7 ft. <br /> Property addresf:: 'AI U j Q( R en a e, n b k <br /> Phone 1: LkaJ 339 '3919. Phone 2: 'OLQ 390 S„c�.t-j- � <br /> Email: klP Kt*' @i V‘et-n C'C. co <br /> c-r1 <br />