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NOTI'PI(A'F'ION TO CLEARiNGHOUgE OF: INTENT TO APPLY'FOR ~SSISTANCE <br /> [SEE INSTRUCIIONS ON I~VERSE) <br /> <br /> (Fei State Use) { 2. Date Form C6mp]eted: [ 3. Anticipated Submittal Dat. <br /> __ _~_~ 9/8/77. 9/]3/7? <br /> ~;,1 .....nr Agency: [ $. PrOject Di~ctor: ] PhonJ' <br /> City of Concord ~ RObert M. Stark t704-786-6161 <br /> Addt¥.~s: [ City: <br /> P,0. BOX'30B,'U" . .' ' [ Concord [ Cabarru~ [ 28025 <br /> <br /> P~ojek-t Title: ] 8. Pro,oct <br /> Logan M~l~i-purpose Co,unity <br /> P~ject ~scription: <br /> <br /> SEE ATTACHED APPLICATION <br /> <br />O. Pre!..ct Also Submitted for Re¥iew To: State Clearinghouse <br /> <br /> ~an: Dash: In-kind: Cash: In-~nd: <br /> ran%}4'000 $ $ $ $ 28,594 $ $ ~ ~2,594 <br />z. Fed~.ral F~g Agency Applied To: ~13. Budgeg Period <br /> ~/d ~;o. o~ Aq;~ ~ From: 10/1/77 To: 1/1/78 <br />4. ~ Source of Other Federal F~mds (~ederal Agency) [15. ~ So.ce of Other Non-Federal F~ds <br /> 0~ - Senior Center - Title V ~ 13.639 <br />~'~2~~ -- .-~-. IV. Enviro~ental Impact_r~omation~~ <br />o. Enviro~ental Statement or Assessment C~CK ONE <br /> ~ Completed (Attach EIS <br /> ~ In Prog~ss (will be su~tted on <br /> ~ Mot Req~r6d DATE <br /> <br />~. Si~.natu~ of C~ef Executive Official of Applic~t ~en~y <br /> 2' <br /> <br /> <br />