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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 leNo ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes ❑ No [ <br /> Do you have a backwater valve orr'ybur sewer line? Yes ❑ No ❑ Don't Know B <br /> Do you have a grinder pump in your basement? Yes ❑ No Eon't Know ❑ <br /> Name: Vi/iJ R 4 r' ' St / <br /> /6 O / GI <br /> Property address: L i�(L,T'Y 1 417 <br /> Phone 1: /.g S -S 7/ -t/a 7(7 Phone 2: 907 — a s9-/oa 41 <br /> Email: ION/V M S E Y £ /n4/L • <br /> . i e.. '1111 <br />