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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 M 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 �J <br /> Do you have a grinder pump in your basement? Yes ❑ No ❑ Don't Know [2( <br /> Name: 1' L��I r2.� e. C�r�► P 1" 1r 2i <br /> Property address: 1 � �3R()Gkm Q- C r Q— <br /> Phone 1:3( O.3O? -1 I (7 q Phone 2: '37O --3c —3 0 fj j <br /> Email: pe \Q i e.. Lnr cr e nCh <br />