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DAWSON COUNTY 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 dawsoncounty.org. I also understand that Dawson County/City of Dawsonville requires a cleanout at sewer tap. I relieve DawsonCounty and its Inspectors from any liability for damages loss of property or improper installation. Company Name State License # Licensed Plumber Contractor Signature Utility Contractor Signature (if applicable) Notary Public Signature and Stamp Date Do you have a restricted license? Yes No If no, sign and date below. If yes, is the scope of work within the license restriction ? Yes No Licensed Plumber Contractor Signature Date W h e n installing an irrigation system if connecting to an existing water supply line backflow protection and rain sensor will be verified at time of final plumbing inspection.