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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 !lowing 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 ❑ Nog Don't Know <br /> Do you have a grinder pump in your basement? Yes ❑ No Or Don't Know ❑ <br /> Name: DIJO ✓ 13W— <br /> ^ <br /> Property address: )2_3 I hit. L-n t✓A <br /> Phone 1: Phone 2: <br /> Email: <br />