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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 M/o <br />If yes, does it have plumbing fixtures (sink, toilet; floor drain, etc.)? Yes 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 ❑ No ❑ Don't Know e <br />Name:- T_�D{ CL� O_ �eA v �oClle�e11�� <br />3sol <br />Property address: �{� �2=�_�i—►-- Cj- <br />j ��u=Tt� g4`2.of <br />Phone 1: __ Phone 2 <br />Email: <br />blll�'ll.i v 'r.r1. <br />.trl _d..f�1 Lt �L <br />