Fillable LBP Inspection Application (Cherokee Nation)

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LBP Inspection Application (Cherokee Nation)

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The LBP Inspection Application (Cherokee Nation) form is 1 page long and contains:

  • 1 signature
  • 5 check-boxes
  • 9 other fields

Country of origin: US
File type: PDF

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Cherokee Nation
Environmental Programs
Lead Based Paint Inspection Application
Name: _____________________________________________
Phone: _____________________________________________
Email: ______________________________________________
Physical Address: _______________________________________________________________
City: ______________________ County: ____________________ Zip: _______________
Mailing Address (if different from above):
______________________________________________________________________________
The following requirements must be met in order to be eligible for an inspection. The inspection
locates positive surfaces with lead based paint and lead dust hazards that may be in your home.
No abatement services are available at this time.
I am a Cherokee Nation tribal citizen.
I live in a home constructed before 1978.
Children under 6 years old live in or visit the home frequently.
The home is not a rental property.
I am not receiving any other housing services offered by Cherokee Nation.
Signature: Date:
____________________________________________ ________________________
For Cherokee Nation Use Only
Date:
Received by:
Comments:
Mail Form: Cherokee Nation Environmental Programs
PO Box 948
Tahlequah, OK 74465
E
mail Form: ashley-wagnon@cherokee.org
or
swest@cherokee.org
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LBP Inspection Application (Cherokee Nation)

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Completed 15 July 2020

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