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Historic District Resource Assessment (RA) Form

|For SHPO Use Only |SHPO Concurrence?: Y / N |Date: |

|Survey Date | |

|Current/Common Name | |

|City, Zip Code(s) | |

|County | |

|Subdivision(s) | |

|UTMs (NAD 83, UTM Zone 11 North) |

|Coordinate # |Easting |Northing |

|# |(enter additional points as needed) | |

|# | | |

|# | | |

|# | | |

|USGS Info |Township: |Range: |Section: |USGS 7.5’ Map & Date: |

|Total Acres in the District | |

|Ownership |Private |Public-Local |Public-State |Public-Federal |Multiple |

|Should the district’s location be kept confidential? |Yes |No |

National Register Eligibility

|Is the district listed in the |Yes |No |If yes, provide:|Date Listed: |NRIS #: |

|National Register? | | | | | |

|If not already listed, complete the information below: |

|Eligible Under: |Criterion A |Criterion B |Criterion C |Criterion D |

| |Not Eligible |Unevaluated | |

|Area(s) of Significance | |

|Period(s) of Significance | |

|Total Resources: |Contributing: |Non-contributing: |

|Integrity – Does the resource possess integrity in all or some of the 7 aspects? |

|General Integrity: |Intact |Altered |Moved |Date(s): |

|Location |Design |Materials |Workmanship |Setting |Feeling |Association |

|Condition of District? |Good |Fair |Poor |

|Explanation | |

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|Threats to Resource? | |

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District Inventory

|SHPO Resource # |name |Address |Year Built |Contributing? |

|and/or Trinomial | | | |(Yes or No) |

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Narrative Eligibility Justification

Provide a detailed explanation of the district’s eligibility for the National Register, including supporting historic information, methods for evaluation under the four criteria, a discussion of the seven aspects of integrity, and conclusions about eligibility.

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Written Description

Provide a written description of the district, including all character-defining features or elements. Be sure to describe accessory resources as well.

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1. References

List references used to research and evaluate the individual property.

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District Location Map

Use a USGS quadrangle map at large extent to show general area of historic district, including district boundary.

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2. Site Plan Map

Use aerial imagery, drafting software, or a hand-drawn sketch (to scale) showing, at minimum, all contributing and non-contributing resources and their spatial relationship to one another.

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Photographs

Include as many photographs as needed to accurately depict the district, including examples of representative properties or property types, streetscapes, landscapes, etc.

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Elevation: Direction facing: Photographer: Date:

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Elevation: Direction facing: Photographer: Date:

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