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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 new ordinance. Please help us verify that our <br /> information is 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.)? Yes No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know le <br /> Do you have a grinder pump in your basement? Yes ikr No ❑ Don't Know ❑ <br /> Name: 41 4 Z .; Alt(.k�'5c)�' el <br /> Property address: 3 l c 1-4 n <br /> Phone 1: LF.1-2 Z-0 7 4( Phone 2: <br /> Email: •S�''���.� 1I"�`' hor s l vet& l! J. cc, �' <br />