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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 Q/ 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 <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know f <br /> Name: <br /> Property address: [63'0 l/JV"\-123A%LQ Qv s-. (890 <br /> n/ [� i <br /> Phone1:ZOO psi 14b6 Phone2: ao6 306 6 t{ '( <br /> Email: 1-1'0,1-? 1C L''exIAA <br /> {l ° <br />