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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 />miormation is correciby answering the follovnng questions about your propeAy: <br />Do you have a basement7 Yes � No ❑ <br />I( yes, does it fiave plumbing fixtures (sink, toilet, floor drain, etcJ? Yes �j No ❑ <br />Do you have a backe�ater valve on your sewer line�.'Yes ❑ No 0 Oon't Know ��� ��S <br />�o/hp/��ej <br />Do you have a giinder pump in your basement? Ycs ❑ No ❑ Don t Know [� ��PG/�L'� <br />/j `��// r h�r .sf�,r'� <br />Name: L.. ��( i%� - '/ G. L� /,�'1 fi � � 2/l i�il <br />L �i/` �� <br />Property address � � � �/ , � E r ��L ��/ ����� <br />Phone 1: � - � �S ' ��v � Phone 7.: d�! �o ' 7 / � - �J6 � ��'' <br />�- <br />/� /� <br />Email: � U %2 � �l l ��J/I .J �3 � ..v.�iL%f i � • C!� �" • <br />1, .,� , ��.- <br />j�� I�I, �,�� � t �''I � e <br />.�d.y��._.....,�.:�, ti�:l�t��a��,_:�.��:.�� <br />