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Show Page 7 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 tor DOES YOUR HOME HEED 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 Name Of Hrmpant Telephone Number. Date IN MAKING EMERGENCY REPAIRS FOR HOME OWNERS AND RENTERS IN THE MODEL CITIES' AREA Family Makeup and Agoc 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 & UtilitiesMonth $ Amount of House Pymt. or Rent Month $ Type of Repairs Needed 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) oooooooooopoooooooooooo HOUSING INSPECTION REPORT d Your Task Force Meeting Recommendations By .Date Advisory Committee Action Signature of Chairman Date |