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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 YiliNo ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes VJ 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 /> CI Name: TO �i `C <br /> iac ent <br /> Property address: {cia' Ri I\ St' <br /> ' <br /> Phone 1: 4 S9 i54 5841 Phone 2: vc 0ll9 539° 0941 <br /> Email: ad •t �/ �S:" AY1D®°CO - <br />