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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 [G"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 LI No ❑ Don't Know I/ <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know <br /> Name: 5 ha IIVIO I Ot'e X <br /> Property address: 110, Z\ide E-w ,E.V C,t/1 y Pt caZAt <br /> Phone 1: y' -' 1- U.$1' Phone 2: <br /> Email: S CO\5•0 15(4,0 S Yv1,9✓1• <br />