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• BACFSW4TER PREVENTION-DEVICE PROGRAM <br /> e`i records"indicate that a backwater prevention device must be installed on your <br /> sevaer connection to comply with the new ordinance. Please help us verify that our <br /> a 'information is correct by answering the following questions about your property: <br /> Do you have a basement? Yes [ No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes d No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know R/ <br /> Do you have a grinder pump in your basement? Yes ❑ No ['Don't Know ❑ <br /> Name: - <br /> Property address: l�`4 � <br /> Phone 1.4a5 <br /> O I /`451 Phone2: q S2or <br /> Email 1 3 - . t l 1 *WS ` II <br /> $$4fL da <br />