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, <br />BACKWATER PREVENTION DEVICE Pf'tOGRAM <br />Our records indicate thal a backwater prevention device must be installed on your <br />sewer connection to comply �vith ihe 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 15� No ❑ <br />If yes, does it have piumbing fixt es (sink, toilet, floor drain, etc.)? Yes � No ❑ <br />Do you have a backwaler valve on your sewer line? Yes ❑ No ❑ Dod� Kno�v��j <br />Do you have a grinder pump in your basement7 Yes � No � Don'1 Know � <br />Name <br />Propertyaddress: t//U /✓ �_��—[�r I" '� <br />Phone �.Z����, �C � Phone 2: � � l �J�I� <br />Email. <br />