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4 <br /> ORANGE COUNTY LOCAL LANDMARK APPLICATION Page 2 of 7 <br /> �� /S / � <br /> PART 1 DATE OFAPPLICATION J` <br /> ...................._............... <br /> Please type, if possible, or print. All submitted materials become the S�T :q..Cqgn!y_ <br /> Historic Preservation Commission and cannot be returned. <br /> ............................... <br /> I. HISTORIC NAME OF PROPERTY (if historic name is not known, use current name or address) <br /> N i Goo -He r r 5 f <br /> 2. LOCATION (physical location, not mailing address) <br /> A, Street or State Route/Highway (\J1 <br /> B. Township <br /> C. Crossroads CommunitylVicinity of <br /> .......... <br /> 3. LEGAL OWNER OF PROPERTY(please indicate Mr., Mrs,, Ms., Dr, or other appropriate title) <br /> . . ........ ........................................................... <br /> DAY-TIME <br /> NAME TELEPHONE <br /> FIRM andfor ADDRESS <br /> C� <br /> 41" V'� 17-3 <br /> L <br /> CITY/STATE ZIP CODE <br /> E-MAIL ADDRESS r) rna co to <br /> BRIEF STATEMENT OF SIGNIFICANCE <br /> Please provide a brief statement or summary outlining the historical, architecture], and perhaps <br /> landscape, elements that make the site significant. (This statement should be expanded for question#5 <br /> of Part 2 of the application.) <br /> t_<-he C-4 Gk) i --_4r y.- <br /> Y-A 41- <br /> V- <br /> � _DrVrJ-'1 41 P r`e S <br /> -a, r ion" e <br /> LIT-- <br /> CAI EL�D±6WQe_V- <br /> 6-f -ff)'f. d uj e I s V1 Ct <br /> *Please submit current pho"t6graphs of the property including all elevations of the main house and any <br /> other important buildings. Please also include general photographs of the property and include any <br /> important landscape features. (if you wish to use digital photography, please submit hard copy printouts.) <br /> 'Please also submit a sketch plan of the property showing the footprint of all key buildings and the <br /> location of all driveways or farm roads. <br />