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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 21<o ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes <br /> 'No ❑ <br /> Do you have a backwater valve on your sewer line? Yes El No E'Don't Know ❑ <br /> Do you have a grinder pump <br /> p in/yyoourr basement? Yes ❑ No ❑I ADon't Know <br /> '1_ <br /> Name: . � Qil-''1 [ •V e' V V�YL. <br /> Property address: 101, CoRAkiN A <br /> Phone 1:1125 a 72--03 Phone 2: 4 d,/ 2 fP f O2- <br /> Email: t \N T-0&v �411 f a/ V <br /> r <br /> tr;� <br />