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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.)? YeNo ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know <br /> Name:LO L 1 <br /> Property address4 4( 2 CO I 0.3L . t t- e-1(1 ` (. <br /> Phone 1: lit' C) ( -'T Phone 2: <br /> Email: 161 'i✓)-�) -1 A -Z ` / i�L�1 <br />