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V <br /> BACKWATER P12EVENTION 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 lko ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes ❑ No 1 <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:y. N11. J ( *d'b \f <br /> Property address: 11 t ( l t MCQ ✓Me_ <br /> Phone 1:`1,9-5 o-g8-73Phone 2: 14 —2-1° 1 2 <br /> Email: t ` tet-Lt.a 1. f(mi l c v c1- 0 C <br />