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Show iaimiii wm&& r Vt? m&kMW i&mjm OTfiSimityiiti Salt Lake Model Cities I , Emergency Home Repair Project , MAIL TO: SALT LAKE CITY-COUNT- HEALTH DEPARTMENT Y ENVIRONMENTAL HEALTH SERVICES 1179 Glendale Drive Phone 359-143- 2 APPLICATION r for Emergency Home Repair Funds DOES YOUR HOME HEED REPAIRS? Sign up now for a Grant! The Salt Lake Model Cities i Property Address - -- - Name and Address of Owner EMERGENCY HOME REPAIR PROJECT REPAIRS FOR HOME OWNERS AND RENTERS IN THE MODEL CITIES' AREA FOR ASSISTANCE Name of Qmipant Date Telephone Number IN MAKING EMERGENCY - - Family Makeup and Ages .n. Source and Amount of Family IncomeMonth $ APPLICATIONS FOR GRANTS NOW ACCEPTING , (which do not need to be repaid) AND LOANS TO PAY FOR EMERGENCY HOME REPAIRS Amount of House Pymt. or Rent Month Type of Repairs UtilitiesMonth & $- ! MppHpH i 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- Desire Both Grant & Loan Desire Loan (Do not write below this line) OOOOOOOGOOOOOOOOOGO0OOOGOGOOOOOO HOUSING INSPECTION REPORT d Your Task Force Meeting Recommendations Got a question about housing? By Hate Advisory Committee Action Signature of Chairman Any question at all, call 467-941- 6 Date I |