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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate that a backwater prevention device must be installed on your <br /> f 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 NJ No ❑ <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+ nd grin <br /> der pump in your basement? Yes ❑ No Don't Know ❑ <br /> Name: 1? <br /> Property address: 1 0 0 C-0 I trf y <br /> Phone 1: Y?' 2S1 3® d Phone 2: YZ ? 9 Z co <br /> Email: r I Cto•-Q is se-$-I tD v.% <br />