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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.)? YesV4 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 Z!�No ❑ Don't Know ❑ <br />Name: 11�)t�-V Xy' o-,kk q F-X!� <br />Property address: A L e U e y 41 <br />Phone 1:j' Phone 2: <br />oL5 9` So <br />Email. If <br />�� "'1;1la 'I: �.. �••7,1�'i. � r rs'.: '� Iti.'1 ' .r�. <br />