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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 nevv"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.)? YesX No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know <br /> Do you haveena grinder pump in your basement? Yes LI NoX Don't Know ❑ <br /> Name: 1► t IChae-1 EVOhS <br /> Property address: 161 5a Stae <br /> Phone 1: 6 v5 s 2-s i '2H Phone 2: �tile" <br /> Email: M e-Uj(AS 55� 6 cokm t {�C"t <br />