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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 VNo ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes`1 No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ Noo Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes ❑ No Don't Know ❑ <br /> Name: -TO BA) .ftL.- <br /> Property address: � t3 \.QOek1./1( OR - <br /> Phone 1: tk2S- � 12—i So3 ) Phone 2: <br /> Email: ,SV y 4$ P CAtb1 CtsT . <br /> 1 <br />