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(Maur r aKd o ti- <br /> 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.)? Yer' `No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't KnovT .... <br /> Do you have a grinder pump in your basement? Yes ❑ Nq Don't Know ❑(/( <br /> Name: 7to''1 <br /> Property address: evi.2/& c;Q Cie/977 <br /> Phone 1:t ^ O 9 Phone 2: <br /> Email: e tier 7a / l2./ dc,Maz.St. 474-- <br /> -„,111` <br /> srac-.w ,u - 111. <br />