Land Use and Environmental Services Agency
Code Enforcement
Liability Waiver for LP Gas Utility Installers
Date: ____________
To: Mecklenburg County Code Enforcement Department
Attn: Document Control/Inspections
(Company Name, address and phone number)
will be installing a:
(Full description)
@Street Address: ____________________________________________________
City: _______________________
State: North Carolina
Zip Code: _____________ Associated Mechanical Permit#___________________
(must have a permitted appliance that you are providing fuel to)
We are installing at the above address, a Liquid Propane Tank/first stage regulator assembly,
associated underground fuel lines to the second stage regulator, in full compliance with the
General Statutes of North Carolina and other laws, rules or ordinances as may be applicable at
the time of installation. As the installation of the piping and both regulators are the responsibilities
of the LP Utility company, we assume all liability for its installation and hold harmless
Mecklenburg County for any and all issues that may arise due to this installation.
Operations/Service Manager