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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 Ut 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 ❑ <br /> Name: • CS _a AIL L IACe <br /> Property address: <br /> C ,fit, �`, 4 , <br /> j <br /> Phone 1:e7 )—' 5.74 Phone- .zc 2: 15f�'1 /`'l� 3 <br /> Email: R tc — rh. tiki\'- V t+.i tr::t D . � . <br />