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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 ❑ 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 l. <br /> Do you have a grinder pump in your basement? Yes ElNo Itz Don't Know ❑ <br /> Name: IA <br /> /�� ,fit <br /> Property address: �/ �� �2�=e?���+ .G!%e%'�� <br /> 13 <br /> Phone 1: / `l i Phone 2 �•2-5 -•�1/g �c <br /> Email: <br /> � , i�`. 2�'" zot!IL- _• __ ._,,.- ., <br />