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<br />, <br /> <br />Effective: 07128193 <br />City ofCentervi1le On!. #57 <br /> <br />&:~1~ <br /> <br />CITY OF CENTERVILLE <br /> <br />SUMP PUMP INSPECTION <br /> <br />Surcharge Applied <br /> <br />Account #: <br /> <br />Inspection Date: <br /> <br />Name: <br /> <br />By: <br /> <br />Address: <br /> <br />Telephone #: <br /> <br /> ACCOUNT TYPE FINDINGS <br />_ Single Family _ Sump PitINo Pump <br />_ Duplex _ Cistern Discharge <br />_ Multiple _ No Sump Pit <br />- Commercial _ Roof/Gutter Spouts in Basement <br /> Institutional _ Other (Specify) <br />- <br /> <br />Comments: <br /> <br />In Compliance <br /> <br />Non-CornpliancelRe-inspection Date: <br /> <br />Page 4 of 4 <br />