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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 th 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.)? YesX No ❑ <br /> Do you have a backwater valve on your sewer line? Yes No ❑ Don't Know ❑ <br /> Do you have a grinder pump-tn yeur basement? Yes ❑ No ❑ Don't Know <br /> Name: <br /> s 4---Q ° W �JG e s -t' <br /> Property address: ,7i Z 2— l-`r o""`4 V s 1 i-A-- <br /> V I.5"'2Y2- c f 3'l k( 1A.- . .1 a <br /> Phone 1: ffialiffiAiiiigfr Phone 2: <br /> Lae- ON24e4 <br /> Email: ( (-e.! \ @ CSC1 <br /> _� �!3'�...a,'``�n x n..,,.._..a,�A _..Ys.;...�..d�l l .:.�'.:. .,..._.. ., .ISM t f`:$s' ..,av,_• $a 2..[2k � <br />