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BACKWATER PREVENTION DEVICE PROGRAM <br />✓ <br />Our records indicate that a backwater prevention device must be installed on your <br />sewer connection to comply wilh the new ordinance. Please help us verify that our <br />intormation 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, toilei, floor drein, etc.)? Yes t[� No ❑ <br />Do you have a backwater valve on your sewer line? Yes ❑ No j� Don't Know ❑ <br />Do you have a grinder pump in your basement? Yes ❑ No � Don't Know ❑ <br />Name: �L� /V �DS % C I� <br />Property address: ,� ��-� � C r%�Ul A/-L ��/E EvERt?-1 <br />� Phonet:���-�%3� d�%� Phone2: <br />EmaiL• Q� 'l` d5 � 1- S 2 �%{9�R/� GD/�'I <br />•--'• . • - - .,-.r.����L.i �_,��.�+ .._�.��J .���i��..• �.� �I _�1�� <br />b <br />