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e,t.va ic.".- <br /> BACKWATER PREVEN r1ON 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 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 ❑ No ❑ Don't Know si <br /> Do you have a grinder pump in your basement? Yes ❑ No`4 Don't Know' <br /> Name: gg$ .J.>rvcf 1 J <br /> Property address: / // 771 l �jr� �h�,�-3. / <br /> Phone 1: �1 l.�2 S- — RPhone 2: c. <br /> Email: T <br /> • � .: . <br /> ,f _ r `. <br />