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_ V <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) No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes ❑ No X <br /> Do you have a backwater valve on your sewer line? Yes ❑ No y Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes ❑ No tYl Don't Know ❑ <br /> 9 <br /> Name: ,it C h,n C �,;� f <br /> Property address: 2_-CG''2- fie -./Se-N LeJ/ <br /> Phone 1: y 2 y2 �7` " '�'Te Phone 2: V Z S —., 3 %' v <br /> / <br /> / / 1 <br /> Email: nh!/<G c G/lv rt4 ce Ce d�L�f0 / ° �--�''`'� . <br />