Declaration of Non-Use Bedrooms
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10 JOHNSTON COUNTY INSPECTIONS DEPARTMENT 309 E MARKET ST SMITHFIELD NC 27577 ? PHONE 919 - 989 - 5060 ? FAX 919 - 989 - 5431 DECLARATION OF NON - USE BEDROOMS DESCRIBE THE PLANNED USAGE OF ANY BEDROOMS NOT APPROVED BY THE ENVIRONMENTAL HEALTH DEPARTMENT ________________________________________________ _____________________ SIGNATURE DATE PLEASE NOTE SIGNATURE MUST BE SIGNED IN FRONT OF NOTARY ______________________________ APPEARED BEFORE ME THIS__________DAY OF ________________________ , 20_____ STATE OF NORTH CAROLINA COUNTY OF JOHNSTON COUNTY SEAL HERE __________________________________________ NOTARY PUBLIC SIGNATURE MY COMMISSION EXPIRES _________________Page