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Show Salt Lake Model Cities Emergency Home Repair Project MAIL TO: HEALTH DEPARTMENT SALT LAKE ENVIRONMENTAL HEALTH SERVICES 1179 Glendale Drive Phone 359-143- 2 CITY-COUNT- Y APPLICATION for Emergency Home Repair Funds DOES YOUR HOME HEED REPAIRS? Sign up now for a Grant! The Salt Lake Model Cities Property Address Name and Address of Ciwner EMERGENCY HOME REPAIR PROJECT Name of Occupant nat Telephone Numher FOR ASSISTANCE IN MAKING EMERGENCY REPAIRS FOR HOME OWNERS AND RENTERS IN THE MODEL CITIES' AREA Family Makeup and Agoc Source and Amount of Family IncomeMonth ACCEPTING APPLICATIONS FOR GRANTS (which do not need to be repaid) Amount of House Pymt. or Rent Month ft AND LOANS TO PAY FOR EMERGENCY Type of Repairs NppHpH NOW HOME REPAIRS FILL OUT THE APPLICATION FORM AND GIVE IT TO YOUR BLOCK LEADER OR YOUR NEIGHBORHOOD COUNCIL REPRESENTATIVE. CALL THEM IF YOU HAVE ANY QUESTIONS. Desire Grant OR APPLY AT ASSIST, INC., 218 E. Fifth South, ENVIRONMENTAL HEALTH SERVICES, 1179 Glendale Drive, Call Approximate Cost for Repair 359-143- 2 Get or 355-708- 5 for applications or information. Involved-Atten- ft UtilitiesMonth $ 1 Desire Loan Desire Both Grant & Loan (Do not write below this line) OOOOGOOOOOOOOOOG0OOO0 HOUSING INSPECTION REPORT d Your Task Force Meeting Recommendations Got a question about housing? By Date Advisory Committee Action Signature of Chairman Any question at all, call 467-941- 6 Date |