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/ <br /> 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 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 116 <br /> Name: 1 I y t ` <br /> Property address: 2..03 1 MG Lb. Oul Ct.t ` 4v-e-. <br /> Phone 1: Lk 2.5•5 $•1C,p Phone 2: <br /> Email: Vi C6 i v 11 Vn•CO eY4 <br /> _,vim <br />