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(1.r(1wad oCti- ho c.C.�vc�Ha <br /> 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 g No ❑ <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 X <br /> Do you have a grinder pump in your basement? Yes ❑ No X Don't Know ❑ <br /> Name: M1eAtCL,st_' -E-t4e, fie_ +Yl vl�c <br /> Property address: 1+3 l 5- Cresi e j i+ AVt ' B,errp I "'A <br /> Phone 1: HZJ-Z5S - `gIA'A Phone 2: 42-70 t32-3 <br /> Email: tv‘l V1 WIFE 0 ) - Co kA, <br />