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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 correct by answering the following questions about your property: <br /> Do you have a basement? Yes N(No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes X.No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No Ig Don't Know ❑ <br /> Do you have a grinder pump in your basement?i Yes ❑1�N.,No ►�Don't Know ❑ <br /> Name: ; ue✓ QJ1 � F OtAj! 4 <br /> Property address: ✓ / Z.5 G rc i w Q A l <br /> Phone 1: n%Z 1... �- —+®!S13 Phone 2: Lf Z�.�ZS Z-I7V1 <br /> Email: ADA)1(N- t 1 -P }iUa-1Wic,V W� <br /> U' <br />