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�,ACKWATER P�EVENTION DEVICE PROGRAM <br /> �' Our records indicate that a backwater prevention device must be installed on your <br /> � ,! <br /> � �` sewer connection to comply with the new ordinance. Please help us verify that our <br /> <;::;;;; <br /> �:� information is correct by answering the following questions about your property: <br /> �`` Do you have a basement? Ye� Na ❑ <br /> !f yes, does it have plumbing fixtures (sink, toilet, floor drain, etc.)? Yes� Na ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Kno�nr <br /> ` Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know� <br /> �� �- � <br /> Name: ���.�`��"°ti ��r'�`�'����� �, �� ��.�,�° <br /> �.��a g '�" a;� ,�..��,:� �, ;;: <br /> '>. t° � °�""��'>$����� �...�'`�� �a a��m� ,�.��§.a� p¢.<��<.`>, ' �°»y" :.s„ �,` <br /> Property address: 1 y=� � � .�_�� �� �� z � <br /> �. �, <br /> � Phone 1: �� �' �� � `��-��`� ' ��� �. Pho ne 2 � �� � � ����" �°��°u;�� � <br /> � <br /> � ,� �" � ���� ,,� � " �� <br /> EmaiL � ��� �:._ ,�_�_ �.,��� ��,� �,,����, <br /> ����8��� <br /> �,� �a � <br /> � .- <br /> �� � _ _ _ _ _ �� <br /> u. <br />