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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 X 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 Tic <br /> Do you have a grinder pump in your basee-m}e_ntt? Yes ❑ No IX Don't Know ❑ <br /> Name: cU S C <br /> Property address: 1 ( +‘i# i9 ie <br /> Phone 1: `t.2,—Z cZ"R 7,3 Phone 2: yZ 2 y YJ 5 2 <br /> Email: C\\%I s1 Sept.-ti5cD e, ,3ynaA1 .COT <br />