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Pe Jj F <br /> w <br /> County ON <br /> f <br /> NORTH CAROLINA HISTORIC STRUCTURE SHORT DATA SHEET <br /> READ and USE the instruction manual to complete this form . Fill it out as completely and consistently as possible . PLEASE NOTE : <br /> not all variables are provided for each question and reference to the instruction manual will be necessary , In 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 /> SURVEY SITE NUMBER � •' r�. • • ' � <br /> ( To be filled in by S & P Branch unless otherwise specified ) <br /> 1 . SITE NAME : L - <br /> 3 . ABBREVIATED LOCATION DESCRIPTION ' OR STREET ADDRESS : ti t '� . CD <br /> Seep <br /> 4 . NEAREST TOWN / COMMUNITY : {J L) <br /> 5 , COUNTY : 6 . DATE RECORDED IN FIELD : MONTH DAYLV <br /> i YEARSannop <br /> 7 . FIELD RECORDER ( S ) : <br /> 8 . TAX PARCEL # ( PROPERTY ID ) : ( optional ) <br /> 10 . OWNER NAME : <br /> 11 . OWNER ADDRESS : <br /> Telephone ,• <br /> 13 . USE : Original Primary : ) • � other .• <br /> Present Primary / Other : <br /> Reside. Farm Resid : No Farm Farm Bldg School Office Bank General Retail Store Industrial <br /> 0101 0102 0201 0301 0401 0402 0501 0601 - 0614 <br /> Transportation Post Office Church Clubhs / Lodge Museum Cemetery Unoccupied <br /> 0801 - 0831 0902 1001 1501 1701 1802 2001 - <br /> 14 . CONDITION : t Excellent Good Fair Deteriorated Ruin Unexposed <br /> ��_ 1 ___• 2 3 4 5 6 <br /> ARCH I TECTLWAL DATA <br /> 19 . EXPRESSION : Exterior c:_C Interior _ High /Academic rWational / Popular Regional /Vernacular <br /> ,J <br /> 1 _ 2 3 <br /> 21 . GENERAL STYLE GROUPS : Exterior : Firstj7 Second _ _ Third <br /> Interior . First _ _ Second _ _ _ Third _ <br /> Geo Geo/ Fed Fed Fed/ Gk Rev Gk Rev Italianate Goth Rev (19 - 20c Trad/Vern`; Queen Anne <br /> 01 02 03 04 05 06 07 <br /> Neoclas Rev Col Rev Misc Vic Standard Com/ Indust Beaux - Arts Tudor Rev Bungalow Art Deco <br /> 12 13 15 16 21 22 25 26 <br /> Ranch Cape Cod Period Cottage Minimal Traditional Craftsman Four - Square Rustic Revival <br /> 35 38 39 40 41 44 45 <br /> 22 . 2PLAN ( DOMESTIC ) : i ._ _ Other : <br /> One Room Hall & Parlor "Other 2 Roart Side Hall Center Hall Irregular Square Shotgun <br /> 01 02 03 06 07 14 17 18 <br /> Augusta 1991 <br />