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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 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 ij Don't Know L <br /> Do you have a grinder pump in your basement? Yes ❑ No a Don't Know ❑ <br /> Name: Cyr lrl.u\ A4Cat C,/,r 'J <br /> /� �@ �p,p��— T <br /> Property address: S caV 6,t-o.lt(i,C�4, A(r ' 4-1/4-- t��t- <br /> Phone 1: 14�S a v ''/ Phone 2: S O <br /> N <br /> Email: <br /> Il -6r41.1 0I C r1168 d 66 <br /> =':I''I .? "fT > o art - - ` <br /> - :7.,717-r.--777-- -,4 .-I--;,„,-..,:.:,,z,e ,.:, ,v,,,,,,,da 4 ,i,, ,II „` , illi:4' ' , d z, L. !,i. * i <br /> n ,ed all bosea p(O M 6 <br /> re tag j ()Iv 10 u s--E 5eWeic <br />