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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 X No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes'R No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No Don't Know ❑ <br /> Do you hav(e� El grinder pump in your basement? Yes No Don't Know <br /> J ❑ <br /> Name: r �O�14 5 q <br /> Property address: �5 1,9 1\i cK . !E -Y <br /> Phone 1: ',b O© l ( Phone 2: 4�-s id 4 k <br /> Email: �t v.'� ( y tin) Gas TN'► C�r e_fi rIn <br /> 4 <br /> ,�. <br />