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V riott r/via f-ed GRc,t,. 1-0 <br /> Q,(,Lt.2t fta-1 ffl� <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 o ❑ <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 Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes ❑ No 1[Z(Don't Know ❑ <br /> Name: E.A- t C— <br /> VfPcr c, <br /> Property address: Gt� ✓ ( Pt - <br /> Phone 1: g gyp. Phone p2: <br /> Email: ei —5 e r �0.•�Ot _, C 6 vn. <br />