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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? YesNo ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes No ❑ <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? L 4® No Don't Know ❑ <br /> Name: `' � - ,.0 <br /> Property address: <br /> q-f <br /> Phone 1: -- 4 --11 hone 2: <br /> Email: ei141 . <br /> 5 <br />