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BACKWATER PREVENTIONDEVICE PROGRAM <br /> Our records indicate that a backwater pvention 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 III NoZ j <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know <br /> _6'4 <br /> Do you have a grinder pump• your basement? Yes LI No ❑ Don't Know y h, <br /> • <br /> Name: P0Af ,i/1V\(444.• '7 <br /> o3 Ru.Gttol.i. ANI‘e, <br /> googioperty address:%5 <br /> IT 0 V 455134N <br /> Phone 1: ier/� ► Phone 2: <br /> Email: Q ,� V�� �� KV C� <br /> � i'c.., ,,.F.3 �_ �.. II.4�.,..S-.as i.�e:.. a. ,f;Nf.fr m��. f�� ., :.,:.I...�;� „1{].. <br />