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•a 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 rier No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes �J( No ❑ <br /> Do you have a backwater valve on your sewer line? Yes No ❑ Don't Know ❑ <br /> Do you have a grinder pump inyour basement? Yes ❑ No Tx Don't Know• <br /> ❑ <br /> Name: Jaco 9 Pe f��r,j► �l <br /> Property address: S-06 1,0 ejimof e Ave <br /> Phone 1: 1-i)c � ggVi3 Phone 2: <br /> Email: „„,b �� ��� ��(� +' , `d <br />