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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 /> i information is correct by answering the following questions about your property: <br /> Do you have a basement? Yesy 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 <br /> Do you have a grinder pump in your basement? Yes ❑ No Don't Know ❑ <br /> Name: \,l C66fl r) °` kJ 00 Id e(I✓�d 1f2 �G�/ <br /> Property address: '!t faf)(1. 4 t/2_ ` <br /> Phone 1:`G..J -O77O Phone 2: T . d� c7 79/ <br /> Email:j . ((i7 ,Vartcjire• Artn< /� CO/ <br /> 4.... _..__fir., . t7 & <br />