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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 El 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 X <br /> Do you have a grinder pump in your basement? Yes ❑ No 71 Don't Know ❑ <br /> Name: C� N Irt i 4 0 J i.l 1��. <br /> r� s <br /> Property address: v t Q tAt 4.i lit t <br /> Phone 1: Li Lc-31-1' 7c3 Phone 2: {2c— —](60 q/05- <br /> Email: C '6 Mark a p 'P r &S 0 . C cw <br />