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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? YesXNo ❑ <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 ❑ <br /> Do you have a grinder pump in your baass ment? Yes ❑ No Don't Know ❑ <br /> Name: T2f,A J \1 V 1 'P <br /> Property address: / /i 7 - i-16 VT- 4 ei <br /> Phone 1: yZ 29,3-6 65'\ Phone 2: 92X 75 6 68J <br /> Email: 6 you Nima ii e- % . e 1 Nr\ux�0c,J. um- QS <br />