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Dawson County Community Development 25 Justice Way Dawsonville, GA 30534 [PHONE REDACTED] PLUMBING SUB-CONTRACTOR AFFIDAVIT Site Address: This is to certify that I am responsible for the Plumbing installation and compliance with all applicable codes. I assume all responsibility and liability for the installation of the building sewer and water lines. I understand that it is my responsibility to ensure that the sewer and water lines are installed in compliance with the Georgia Minimum Plumbing Code and any local ordinances. Ordinances may be reviewed at dawsoncountyga.gov. I also understand that Dawson County requires a cleanout at the sewer tap. I relieve Dawson County and its Inspectors from any liability for damage, loss of property, or improper installation. When installing an irrigation system, if it is being connected to an existing water supply line, backflow protection and a rain sensor will be verified at the time of the final plumbing inspection. Do you hold a restricted license? Yes No If yes, is the scope of this work within the license restriction? Yes No Company Name State License Number Expiration Date Print Licensed Plumbing Contractor Name Date Contractor Email Contractor Phone Number Licensed Plumbing Contractor Signature Notary Signature Notary Stamp