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SEA LE <br /> BACKW4MEIMBEVENTION DEVICE PROGRAM <br /> Our records1 cate fiat abackwater prevention device must be installed on your <br /> sewer Conn 6 damply 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? YesNo ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes ig 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: o � ��9 it\ti <br /> Property address: <6 0 5 e✓ E.Nri'vii1W4 43'2 <br /> 4. <br /> Phone 1: --6kiS Phone 2: ®',23 i " 1423 <br /> Email: dencadcl.(11 i4. �r eP o QOP <br /> .:` rL,1d. is <br />