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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 Vo ❑ / <br />If yes, does it have plumbing fixtures (sink, toilet, floor drain, etc.)? Yes L No <br />Do you have a backwater valve on your sewer line? Yes ❑ No ❑ Don't Know <br />Do you have a grAder pump in .your basement? Yes ❑ No ❑ Don't Know <br />Name: / •/ Cyr LV c.iicrc•a <br />Property address _ GG� L� <br />Phone 1; Gl r J��/one 2: <br />Grnail � �- <br />i <br />IN <br />