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$ACKWATER PREVENTION DEVICE PROGRAM <br />Our records indicate Ihat a backwater prevention device musl be installed on your <br />se�ver conneclion to comply with Ihe new ordinance. Please help us veri(y Ihat o�r <br />intormation is correcl by ansedering the followinq queslions about your property: <br />Do you have a basement? Yes �f] No ❑ <br />I( yes, does it have plumbing fxturec (sink, toilet, floor drain, etc )7 Yes � No ❑ <br />D� you have a backv�aler valve on your s�wer line? Yes 0 No � Don't Know ❑ <br />Do you have a grinder pump in your basemenl? Yes ❑ No �j Don't Know ❑ <br />Name ��-'-� 1� �'� ,(,,.1 c'G�T� <br />Property address �y I� VJ--�l� i t::. "(- V--z-- <br />Phone(l:�i.��� _ �.z-75 I�l Phone2: <br />Email <br />J <br />� i � .( � � �'..�. � --.1.�• <br />�_':,1.u._.��_ .. - ---_----. .._.:1_ .�' �� <br />