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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backwater prevention device must be installed on the sewer <br /> connection at the address identified on the enclosed letter. 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 ❑ No ❑ G-Q r 6'p <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain__!!,etc.)? Yes ❑ No 2( <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,Fel Don't Know ❑ <br /> Name: Mt &t 46/)A f 611 <br /> Property address: I3 <br /> Phone 1: Phone 2: �j Q <br /> Email: lz I jG A fi l"%et f� S /1-12 <br /> .a; t <br />