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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 ❑ 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 /> Name: M L TO\l 1�ISFNP <br /> Property address: IS 13 1377H 3 ) U I-1 IT 12 Q� <br /> Phone 1:Lj25-9Z3"'62; Phone 2: (-12 5—C123 " (15 <br /> Email: • <br />