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0114t ar r -r-64 ota- i e(,vat I-fw <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 Xi No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes 1K No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know <br /> Do you ha'v�(e�a grinder pump in your basement? Yes El No ❑ Don't Know XS <br /> Name: ikc ,LCsf <br /> Property address: 3 2.2 rand Ave I 9g2. <br /> Phone 1:2E-1—1 1` J5Q Phone 2: <br /> Email: �LC,*k e hal el J •C©1'l <br />