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Get K-3 SHPO Building Survey Form - Town Of Union

RD, NY 12188 -0189 QUAD (518) 237-8643 NEG. NO. YOUR NAME: DATE: YOUR ADDRESS: TELEPHONE: SERIES ORGANIZATION (IF ANY): ******************************************************************************************* IDENTIFICATION 1. BUILDING NAME(S): 2. COUNTY: VILLAGE: TOWN/CITY: 3. STREET LOCATION: 4. OWNERSHIP: a. public b. private 5. PRESENT OWNER: ADDRESS: 6. USE: Present: Original: 7. ACCESSIBILITY TO PUBLIC: Exterior visible from public road: Yes No Interior accessible:.

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