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State of California The Resources Agency DEPARTMENT OF PARKS AND RECREATION OHP Number:
1. 2. 3.
Common Name: Historic Name: Designations: State Historical Landmark: National Register eligibility/listing: (code) Local listings: State Park System Unit: DPR Facility Number: County: USGS Quad (name, date, scale): Township: Land Grant: UTM coordinates: zone: Elevation: Location/Address: Surroundings: ____ Open Land; m North; m East Range: Base Meridian:
; date listed:
Approximate lot size (in feet): Structure Dimensions (in feet): long; wide; stories
Structure is: ____ on original site; ____ moved; _____ not known. Architectural Style:
2
State of California The Resources Agency DEPARTMENT OF PARKS AND RECREATION OHP Number:
HISTORIC STRUCTURE INVENTORY 18. Briefly describe the present physical appearance and condition of the structure:
19.
Alterations / Restorations:
20. 21.
_____Deterioration;
_____Vandalism;
22.
23.
Architect: Architectural Drawings: Builder: Construction Date: Previous surveys, sources and references:
3
State of California The Resources Agency DEPARTMENT OF PARKS AND RECREATION OHP Number:
29. 30.
31.
Briefly state historical and/or architectural importance (include dates, events, and persons associated with the site):
32.
Main Theme of the historical resource (if more than one is checked, number in order of importance):
_____Architecture _____Agriculture _____Government _____Military _____Commerce _____Technology _____Mining _____Industry _____Social _____Recreation _____Education _____Arts _____Exploration _____Religion _____Settlement _____other:
36.
Attachments:
4
State of California The Resources Agency DEPARTMENT OF PARKS AND RECREATION OHP Number:
37.
Foundation Description:
_____Stone _____Brick _____Wood _____Concrete _____Mortared _____Unmortared _____Post _____Pier _____Continuous _____Sill _____Skid _____other:
38.
Cellar Description:
_____Pit, lined with:_____Wood, _____Stone, _____Concrete; _____Stairs; _____Ground level entrance from the _______________ _____Remains of doorway present:
39.
Exterior Siding:
40.
Roof:
41.
Windows:
42.
Doors:
43.
Ceilings:
44.
Floors:
45.
46.
Paint Colors:
47.
Framing:
48.
Fireplaces:
49.
Built-in Features:
5
State of California The Resources Agency DEPARTMENT OF PARKS AND RECREATION OHP Number:
51.
Nail Types:
52.
Lumber Dimensions:
53.
54.
55.
Utilities:
56.
Security Systems:
57.
Landscaped Vegetation:
58.
59.
Natural Vegetation:
6
State of California The Resources Agency DEPARTMENT OF PARKS AND RECREATION OHP Number:
_____Depression _____Embankment
_____Tunnel _____Pit
61.
62.
63.
Soil:
64.
65.
Remarks:
66.
Additional References:
67.