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BACKWATER PREVENTION CIEVICE PROGRAM <br /> Our records indicate that a backwater prevention device must be installed on your <br /> • • sewer connection to comply with the new or•.drnance. 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 No ❑ <br /> v1 <br /> If yes,does it have plumbing fixtures(sink,toilet,floorrain,etc.)? Yes t No ❑ <br /> N6 �n70 <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know'4 <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know <br /> Name: l j / [ P A--7TLISo 41 <br /> Property address: 700 f y 7-- <br /> Phone 1: q..) '- o��� -07 a {Phone 2: -- <br /> Email: G ie'2ztm-tee- (�' - b?J• (`1S'Yz- <br />