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BACKWATER PREVENTION DEVICE PROGRAM <br /> 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`,No ❑ <br /> If yes,does it have plumbing fixtures(sink,toilet,floor drain,etc.)? Yes X(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: UIlrIJ 14 No Q\v N <br /> Property address: �csU (2-()L\C l✓L>_�(k, AVE <br /> Phone 1: S(9U —S4-k°7- Phone 2: <br /> Email: rA r, y✓\e.ki"c-Uh wyktr • CG <br /> Li . ... *€.41j'.'. ,u <br />