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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 n$w c5rdinance. Please help us verify that our <br /> information is correct by answering the following questions about your property: <br /> Do you have a basement? Yes ❑ No V <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes ❑ No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No V Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes ❑ No II.'6on't Know ❑ <br /> Name: Jeff . o �'S <br /> Property address: Z '1 Chi fJ/! / . <br /> Phone 1: Z j Z,5-91 2ei13 Phone2: <br /> Email: <br /> 3L 5{�. sax <br /> a..-Std 3s :_ as+ ..nY.._3�`_2I .:u 'et$I 'd' :� Z ii'bi. <br />