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BACKWATER•F REVENTK3N 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 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 on't Know ❑ <br /> Do you have a grinder pump in your basement? Yes ❑ Noon't Know ❑ <br /> Name: WA Z1 w\ t^"A e--1YV\ ,1 <br /> 5 42 ( <br /> Property address: '�'0if�C(��\Q1j/�e— ,\Phone 1: 142 ' C11"rPhone 2: <br /> Email: Y V A 2t u l ,C ctA <br />