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BACKWATER PREVENTION DEVICE PROGRAM <br />Our records indicate that a backwater prevention device must be instailed on your <br />sewer connection lo comply with the new ordinance. Please help us verify that our <br />informalion is correct by answering the following questions about your propeAy: <br />� <br />Do you have a basement? Yes �No ❑ <br />If yes, does it have plumbino fixlures (sink, toilet, floor drain, etc.)? Yes � No ❑ <br />/ <br />Do you have a backwat� r valve on your sewer line? Yes ❑ No ❑ Don't Know,%K] <br />v ` <br />Do you have a grinder pump in your basement? Yes ❑ No� Don't Know ❑ <br />Name: � �f �t%�' /V � � � <br />PropeAy address: <br />.� 71/ RR�N/t�-- �V� � <br />t Phone 1: `',�1-S rJ � l� %� Phone 2: �L �.5�� ��j�—J' <br />1 <br />Email: I' �i � A � � � � � �� � -�� <br />, � '� ��. . ,. <br />�.uun���_7::�..1L_......•''��:' 1i3i't_�5...a�.:J_.:�.i1:.,iF <br />.f� _ . wt�•J:a .. ... <br />