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BACKWATER PREVENTION .$ ICE PROGRAM <br /> .a <br /> Our records indicate that a backwater prevention device must be installed on the sewer <br /> connection at the address identified on the enclosed letter.Please help us verify that our <br /> information is correct by answering the following questions about your property: <br /> �^� <br /> Do you have a basement? Yes XNo ❑ &O( I-3 h FOB APT": <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 54 <br /> Do you have a grinder pump in your basement? Yes ElNo D3r Don't Know ❑ <br /> 41-6)( <br /> Name: // 0 <br /> Property address: 26 7 I 1 E A <br /> Phone 1: 1,/Zej 3 J l 2-9S Phone 2: 7ZS a178- I [�l <br /> Email: 44 L c c /1(54.1 • c�� <br />