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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 ,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 14 <br /> Do you have a grinder pump in your basement? Yes ❑ No (g Don't Know ❑ <br /> 'O1 <br /> Name: Z' '"I 412JCE ! <br /> Property address: r00 / 11- AVE <br /> Phone 1: 04.08'84 64 Phone 2: T`'A 5'4" / ` 3 • <br /> Email: y. �� ,� MO( VANNYYZ ieorrAt .Co 1 <br /> r } <br /> ..a �.. _.:��Tc 1.s=A x.^. ,.�f.��++v1 v a SY::.Y..Y_n! f u,.. .n .. �`S , '. <br />