Healthy Houses Interest Form

Healthy Houses Interest Form
This form is to express your interest in the Healthy Hsoues Program. Once you have completed this form you will receive an email that contains the additional information that will be needed from you, the property owner, as well the tenants.

Compelting this form does not gurantee acceptance into the Health Houses Program.
Property Owner Information
Name of Property Owner*

First NameLast Name
Property Owner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

HVAC System
Is the current HVAC funtioning?*

Yes, but needs repairsYes, but it's oldNo, it is not functioningThere is no HVAC currently at the property
Age of HVAC System*
HVAC Needs*
Repairs, Replacement, Etc.

After Submitting this Interst Form Lake County staff will follow-up with next steps.

In order to participate in the program, DO NOT sign a contrat for HVAC work until instructed to do so by Lake County.
Should be Empty:

Property Owner Information