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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? Yes NI.No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor r drain,etc.)? Yes',No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No LI Don't Know'' <br /> Do you have a grinder pump in yourbasement? Yes ID No <br /> No 0 Don't Kno <br /> Name: J 0/// //1 te/ <br /> Property address: /3/C /61. /'D,_(? A -& <br /> Phone 1:9�aS 3f-5-9- '( Phone 2: <br /> Email: CA <br /> ��1 n'1 rn 1Y-4 t, / E_ y Cf 11 t3 �� <br />