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BACKWATER PREVENTION DEVICE PROGRAM <br /> Our records indicale that a back�valer prevention device must be installed on your <br /> sewer conneclion lo comply wilh lhe nee+ordinance. Please help us verify ihat our <br /> informaGon is correct by ans�vering the following queslions aboul your property: <br /> Do you have a basement7 Yes� No ❑ <br /> If yes, does it have plumbing fixtures (sink, loilet, Floor drain, etc.)? Yes� No ❑ <br /> Do you have a backwater valve on your,ewer line7 Yes 0 No ❑ Don't Know�' <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know,� - ha✓'G <br /> % <br /> Name: ��rrLC( SL:c'�}-� S L'- - G� --5 S n +1 M� <br /> Property address: _�_�[���✓ �-- <br /> ' Phonel: �Z5`� 5,� • �u'"?��J' Phone2: �i_,� '33 �• ���3- <br /> Email: �—F_�P_SSe=Le-� S��mt-c� � ' G's»-i - <br /> � i ,, �� .._i .� i, <br /> , � <br /> w�M.����+1� ... . "l :.i ' �.. . . � �. '.� . 1,. . . ..'l. .. ... L.: <br /> � <br />