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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? Yes f No ❑ <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 ig <br /> Do you have a grinder pump in your basement? Yes al No LI Don't Know lg <br /> SisoP /'- (' —'ie.i <br /> Name: ei C/k/Z L. 5 Evo O N <br /> Property address: 41[ 6 11Q b Ate: <br /> Phone 1: 2- 1 -1 [9-3 Phone 2: <br /> Email: ah dre4 a Yfc 4,sek..eO L( diet- <br />