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Show rvfc, JttiwNiefreiWtoaite witln iwTitiifiiMmiiin fMitniUMlftriiti 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 r, APPLICATION tor DOES YOUR HOME NEED REPAIRS? Emergency Home Repair Funds 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 Dm i pant Date.,.,. Telephone Number REPAIRS FOR HOME OWNERS AND RENTERS IN THE MODEL CITIES' - Family Makeup and Ages 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 I I ? Type of Repairs UtilitiesMonth $ & NppHpH FILL OUT THE APPLICATION FORM AND GIVE IT TO YOUR BLOCK LEADER OR YOUR NEIGHBORHOOD COUNCIL REPRESENTATIVE. CALL THEM IF YOU HAVE ANY QUESTIONS. I 4 Amount of House Pymt. or Rent Month & 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 or 355-708- 5 for applications or information. Get Involved- Attend Your Task Force Meeting Desire Both Grant & Loan Desire Loan (Do not write beiow this line) oooooooooooooooooooooooooooooooo HOUSING INSPECTION REPORT Recommendations Got a question about housing? By - Date Advisory Committee Action Signature of Chairman 467-941- Date 6 iv |
