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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 359-143CITY-COUNT- Y 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 Ownpr EMERGENCY HOME REPAIR PROJECT FOR ASSISTANCE IN MAKING EMERGENCY Name of Occupant rtP 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 Amount of House Pymt. or Rent Month UtilitiesMonth $ & Type of Repairs MppHpH 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 or 355-708- 5 for applications or information. Get Involved- Attend Your Task Force Meeting Desire Both Grant & Loan Desire Loan (Do not write below this line) oooooooooooooooooooooooooooooooo HOUSING INSPECTION REPORT Recommendations By Date Advisory Committee Action Signature of Chairman Any question at all, call 467-941- 6 Date |