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BACKWATER PREVENTION p0.10E PROGRAM <br /> 1 Our records indicate that al 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 RiNo ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes R(No ❑ <br /> Do you have a backwater valve on your sewer line? Yes lierNo ❑ Don't Know ❑ <br /> Do you have a grinder pump in your <br /> basement? Yes ❑ No [Don't Know <br /> Name: ?4 &L t+ c 0! <br /> Property address: � (� LQ j� � s v t.E'I1 ye/0/ <br /> (��� <br /> Phone 1: 42 �--ice Phone 2: ----- <br /> Email: /0 vt'Pi <br />