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ut,tcu kex t-ed p(Cc,. 1-0 La.cct f- r- t1-t _ <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 g.No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes XJ 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'Don't Know <br /> Pau ❑ <br /> Name: _ 'J .0N-'! I1 W <br /> Property address: ?33. �2'�'�� A vt <br /> Phone 1:(7)1 S 35 f-43tPhone 2: (c27() ) 4 ,S <br /> Email: roppMA <br /> 0..±Qly3O )10 I1141../ 1. CD_ <br />