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V <br /> 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 k No ❑ <br /> Do you have a backwater valve;on your sewer line? Yes ❑ No ❑ Don't Know N. <br /> Do you have a grinder pump inyo►r basement? Yes ❑ No ❑ Don't Know <br /> Name: t_ <br /> ►SQ Zell <br /> Property address: ✓)IS- 1(0iY1 ✓t- " Ve^-ZS LOA '2W <br /> ) <br /> Phone 1: aC"4$ 1 s'3 14 Phone 2: 12 L—Li W Li <br /> Email: ` 0t-t'ecknetl 'PC001Ca$+. vie-f-- <br />