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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 "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 `2 ksti <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know 15 �J <br /> Name: .a.C'D Lus e' <br /> Property address: ( 1 1 0 CoW y T�v`�.• <br /> Phone 1: `J` GQ 5 A if s Phone 2:q,� "T 32a <br /> Email: 3 e 0.5Vu- ,swt.\0.0 z`1°YN <br />