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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our'ri3'cords 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 ANo ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes ❑ No /2 <br /> Do you have a backwater valve on your sewer line? Yes ❑ No,_Don't Know. <br /> Do you have a grinder pump in your basement? Yes ❑ No$Don't Know ❑ <br /> Name: J /\f <br /> Property address: /5:0 Rade-le...6e_ Ave <br /> Phone 1: 9,q5 �S%?®Phone 2: ' 5 3 70030 ) <br /> Email: rjek-U,Se CitYM <br /> ... 4 m , <br />