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f., 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%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 I% Don't Know <br /> Do you ha�1vea grinder pump in your basement? Yes ❑ No ri Don't Know ❑ <br /> Name: l7.1 r 0 /o/ g < .€ 4 - <br /> Property address: / Z-d2 y 1 /t y . <br /> Phone 1: 9--,j-1,-Ci-- d 2- Phone 2: <br /> Email: <br /> - ..q",,.,.. .,..,,K .". „..x.;..,.. _ i�t .,n.:L.. 'Y'ill AP/'' . ..,.. ..,f_ t At <br /> , <br />