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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 ig 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 $J <br /> Do you have a grinder pump in your� basement?,, (1Yes El No X Don't Know ❑ <br /> Name:a{�1 / <br /> ( l� . ` .Qc,(,hl\.� 1f ( \.t fL 1`\ <br /> Property address: 3(00") I45Y11 r A '-'-c C <br /> Phone 1: 06 ?86 3,5V Phone 2: le <br /> Email: agh'et G/PitiC °_ CJ - Cf-2,2-7 <br />