Certificate of Compliance

with the

Inefficient Plumbing Fixtures Replacement Plan Ordinance (Section 25-45 through Section 25-60)

Purchasers of properties constructed before 1993 must submit this Certificate of Compliance certifying that all structures

on the property only contain water conserving plumbing fixtures before obtaining water service. The service address must

be inspected by a licensed plumber or home inspector and this certificate must be signed verifying that all plumbing

fixtures are water conserving fixtures. If your property is exempt from compliance, you must submit the Exemption Form

with your application for water/sewer service.

__________________________________________________________

(Please Print) Applicant’s Last Name First Name MI

_________________________________________________________________________________________________

Service Address City State Zip Code

I, ________________________________________ pursuant to the laws of the State of Georgia assert under

(Inspector’s Name)

penalty of perjury, that all structures on the property only contain water conserving plumbing fixtures and that all

other kinds of plumbing fixtures have been removed from all structures on the property.

__________________________ ______________________________ _____________ ___________________

Licensed Plumber, Print Name Signature Date GA License Number

___________________________ _______________________________ _____________ ____________________

Home Inspector, Print Name Signature Date Business License Number

Please fax this certificate, along with your application for water/sewer service, to Treasury and Accounting Services at 404-687-3504.