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�Sll <br />County " r6 ;1 <br />NORTH CAROLINA HISTORIC STRUCTURE SHORT DATA SHEET <br />. • his, ..s•' <br />READ and USE the instruction manual to complete this form. Fill it out as completely and consistently aspossible. PLEASE NOTE: <br />.+i.;;jr., j.1! 1 <br />not all variables are provided for each question and reference to the instruction manual will be necessary�Nln all cases: <br />0 or 00 denotes an undetermined or not applicable response <br />9 or 99 denotes a variable other than those provided <br />i. <br />SURVEY SITE NUMBER Ll �O(To be tilted in by S & P Branch unless otherwise specified) <br />Co 1.1. SITE NAME: t 1 � � t,(. rl ri, u <br />3. ABBREVIATED LOCATION DESCRIPTION OR STREET ADDRESS: <br />4. NEAREST TOWN /COMMUNITY: I-hl►s�>�1'b VrtJ i 'ra:: " <br />5. COUNTY: _V 6. DATE RECORDED IN FIELD: MONTH _ DAY 1'YEAR <br />7. FIELD RECORDER(S): G �i" t L T1 IBC, <br />8. TAX PARCEL ## (PROPERTY ID): (optional) <br />10. OWNER NAME: <br />11. OWNER ADDRESS: <br />Telephone: <br />13. USE: Original Primary: 6 t _(?�l <br />Present Primary : 1% L 0? <br />Resid: Farm Resid: Non -Farm Farm Bldg <br />0101 0102 0201 <br />Transportation Post Office Church <br />0801 -0831 0902 1001 <br />14. CONDITION: J-1 Excellent <br />1 <br />ARCHITECTURAL DATA <br />19. EXPRESSION: Exterior 3 Interior 3 <br />21. GENERAL STYLE GROUPS: Exterior: <br />Interior: <br />Geo Geo /Fed Fed Fed /Gk Rev <br />01 02 03 04 <br />Neoclas Rev Col Rev Misc Vic <br />12 13 15 <br />Ranch Cape Cod Period Cottage <br />35 38 39 <br />22. PLAN (DOMESTIC): 0 �_ <br />One Room Hall & Parlor <br />01 02 <br />Other: <br />Other: <br />School Office <br />0301 0401 <br />Clubhs /Lodge <br />1501 <br />Good Fair <br />2 3 <br />Bank <br />0402 <br />Museum <br />1701 <br />General. Ret# G,Store <br />,'0503 „a. <br />Ceme>:ery <br />1802 j' <br />a <br />Industrial <br />0601 -0614 <br />Unoccupied <br />2001 <br />Deteriorated : <;tRuin Unexposed <br />4a 5 6 <br />High /Academic National /Popular <br />1 2 <br />First Second <br />First Second <br />Gk Rev Italianate Goth Rev <br />05 06 07 <br />Standard Com /Indust Beaux-Arts <br />16 21 <br />Minimal Traditional Craftsman <br />40 41 <br />Other: _ <br />Other 2 Room <br />03 <br />Reg i ona ljVe`r.nacu t a r <br />13 ` i, <br />T r0 °fir <br />19 -20c .Trac <br />09 <br />i, <br />Tudor Rev <br />22 <br />Four-Swai <br />44j 1 <br />Side Halt Center Hatt Irregular,.': <br />06 07 <br />Queen Anne <br />M Art Deco <br />26 <br />Rustic Revival <br />45 <br />Shotgun <br />18 <br />