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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 No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes g No ❑ <br /> Do you have a backwater valve on your sewer line? Yes ❑ NoDon't Know' <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know <br /> Name: ©e—J i kL v levy <br /> Property address: l /'q / t'eiLs / tog 9 F <br /> Phone 1: -2,0 3 9/ 2 ''/3 Phone 2: 4/02.,5 F / 3 r,Z27 <br /> Email: J t9t?—/4,1 /c van d_.,/ <br /> Rs <br />