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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 El (0/1/�/A, ,�'J".4rilY�y�// <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 grinder pump in your basement? Yes ❑ No Don't Know ❑ <br /> Name: <br /> Property address: /o < !1 <br /> Phone 1: t"...:5 s .9) ! Phone 2: �� r goo <br /> Email: 14i ems.11-6 hel JAx-3412 ee'M r!-G?' <br /> s s <br /> 3 . <br />