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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicate,that a,backvitafer prevention device must be installed on your <br /> sewer connection to co"mply'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 if <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes ❑ No ❑ Nfr, <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know i <br /> Do you have�a grinder pump in your basement? Yes ❑ No ❑ Don't Know❑ NA <br /> Name: \1t) 1� (i?a4ic. ` <br /> Property address: LiSaS C►ems e 1 Ave <br /> Phone 1: if as--2 Zq I S Phone 2: <br /> Email: JOtnr-C3 nAoo -Com <br /> .v5-:< E ts- <br />