Primary Record Form
| State of California -- The Resources Agency Primary #_______________________ |
| DEPARTMENT OF PARKS AND RECREATION HRI #__________________________________ |
| PRIMARY RECORD Trinomial______________________ |
| NRHP Status Code__________________ |
| Other Listings________________________________________ |
| Review Code____________Reviewer____________Date______ |
Page___of____
*Resource Name or #: (Assigned by recorder)
P1. Other
Identifier:______________________________________________________________________________
*P2. Location: p Not for Publication p Unrestricted *a. County________________________________________
and (P2c, P2e, and P2b or
P2d. Attach a Location Map as necessary.)
*b. USGS 7.5' Quad___________________ Date_________ T___ ; R___ ; ___¼ of___ ¼ of
Sec___ ; SBr B.M.
c. Address________________________________
City______________________________ Zip___________
d. UTM: (Give more than
one for large and/or linear resources) Zone 11, ___________mE/ ___________ mN
e. Other Locational Data: (e.g., parcel #, directions
to resource, elevation, etc., as appropriate)
*P3a. Description:
(Describe resource and major elements. Include design, materials, condition, alterations,
size, setting,
and boundaries)
*P3b. Resource Attributes: (List attributes and
codes)_____________________________________________________
*P4. Resources Present: o Building o Structure o Object o
Site o District o Element of District
o Other (Isolates, etc.)
| P5b. Description of
Photo: (view, date, accession #)
|
P5b. Description of
Photo: (view, date, accession #) ____________ ______________________________ *P6. Date Constructed/Age and Source: o Historic o Both o Prehistoric _______________________________ _______________________________ *P7. Owner and Address: ______________________________ ______________________________ ______________________________ *P8. Recorded by: (Name, affiliation, and address) ___________________ ______________________________ ______________________________ *P9. Date Recorded_____________ *P10. Survey Type (Describe): ______________________________ ______________________________ *P11. Report Citation: (Cite survey report and other sources, or enter "none") |
| ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ |
*Attachments: oNONE oLocation
Map oSketch Map ¨Continuation Sheet ¨ Building, Structure,
& Object Record |
For Archaeological Site Record Click Here