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Show UMiiniiimim jfcSani ui Salt Lake Model Cities Emergency Home Repair Project MAIL TO: SALT LAKE CITY-COUNT- HEALTH DEPARTMENT Y ENVIRONMENTAL HEALTH SERVICES 1179 Glendale Drive Phone 359-143- 2 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 Owner EMERGENCY HOME REPAIR PROJECT FOR ASSISTANCE IN MAKING EMERGENCY Name of Orrnpant riato Telephone Numher REPAIRS FOR HOME OWNERS AND RENTERS IN THE MODEL CITIES' Family Makeup and Agoc AREA Source and Amount of Family IncomeMonth $ NOW ACCEPTING . APPLICATIONS FOR GRANTS (which do not need to be repaid) AND LOANS TO PAY FOR EMERGENCY HOME REPAIRS FILL OUT THE APPLICATION ANY QUESTIONS. Type of Repairs MppHpH Approximate Cost for Repair Desire Grant OR APPLY AT ASSIST, INC., 218 E. Fifth South, ENVIRONMENTAL HEALTH SERVICES, 1179 Glendale Drive, 359-143- 2 Get or 355-708- 5 UtilitiesMonth $ FORM AND GIVE IT TO YOUR BLOCK LEADER OR YOUR NEIGHBORHOOD COUNCIL REPRESENTATIVE. CALL THEM IF YOU HAVE Call Amount of House Pymt. or Rent Month ft for applications or information. Involved-Atten- Desire Both Grant & Loan Desire Loan (Do not write below this line) oooooooooooooooooooooooooooooooo HOUSING INSPECTION REPORT d Your Task Force Meeting Recommendations By OatP Advisory Committee Action Signature of Chairman Date |