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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 /> Ksez <br /> Do you have a basement? Yes No CIlac f7Aa• <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes jk No <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know M <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know in <br /> Name: <br /> Property address: IL o-} I,11.4-x►rt Ave <br /> _ 7Y•Y/9t <br /> Phone 1: V Z- • tl 6/6 i< Phone 2: y=r•40401111111* <br /> Email: r 3 S e.ve#S•fie.co►v. <br />