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`AW,Sy <br /> . {3ACKWATER 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° 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 g <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know Ni <br /> Name: X'i4-1 e✓el/ �r-� <br /> Property address: , ? '& 347 C <br /> Phone 1: 42-S—'2 /-663 J Phone 2: <br /> Email: 14_7-1,t gc <br />