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Vt4d1111 Gj Got Fla( (AA_ w z C.t,vet kx,. ft- <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 1A,No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes 14 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 /> Name: /�(i/�``�/ ,f/7L Q1/n <br /> Property address: 33// i2 /)Z c - C r � + /dhCIr <br /> Phone 1: �✓ -,; -1P7d Phone 2: ; 3 / <br /> Email: i2I2a c.L , (,'G`I)71MMi5f, /J�.f <br />