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I <br /> 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? YesX"No Li <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes ❑ NoX <br /> Do you have a backwater valve on your sewer line? Yes gNo ❑ Don't Know ❑ <br /> Do you have a grinder pump in.:.o*basement? Yes ❑ Noo Don't Know ❑ <br /> Name: <br /> Property address: (4Z1 G A 146 �C�/a✓ �J� `"JAI <br /> Phone 1: iitCI Phon�e�2: <br /> Email: 1`ZY•-G- .\Y JO a' cr..J. • Gp,� <br /> • <br /> -. a,-77777 ,. '��'Ti'-+..w"�w.,x➢ .,i..,.t- d,.X . <br />