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J <br /> 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? YesA No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes ❑ No>4 <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know' <br /> Do you have a grinder pump in yourr basement? Yes ❑ No El Don't Know <br /> ItoA.Name: k {e �1 <br /> Mack <br /> Property address:C ' C,d" O/AA Nei VC/CAA' q -"" ! <br /> Phone 1:(i` !/ tql010 Phone 2:C7,00*....) 1` 1 I F I <br /> Email: lii Aalel f P V l'" V i <br /> „ . .n AS a .a iit. <br />