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= k,..::, -,...=,,,,t, 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 e 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 ° No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know <br /> ,�,�j <br /> � Name: OLA ,,l <br /> ;, Property address: - % f <br /> C +�l <br /> Phone 1: t V - 31 Ti' -I-30Phone 2: t. 1 i»:VI) <br /> 9 <br /> Email: 0- . .. . t . (0..."," <br /> 10- • R <br /> F ' <br />