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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 po ❑ <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 [k Don't`Know ❑ <br /> Do you have a grinder pu = 'n your .aseme t? Yes ['No ❑ JDo�n't Know ❑ <br /> Name: ,/ I 11 .r _ r ( /` <br /> B -111 , S VW- , .. <br /> Propertyaddress: /r_l G /-� , � � <br /> Phone 1: 4)5—3�� J 1�7C( Phone 2: q- p —10S <br /> Email: LJV)L � �11V�a( 1 t1111 <br /> • <br /> C W\ <br /> { <br />