Heritage Application Form - Municipality of Colchester

Name of Property(*)

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Location(*)

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Present Owner(*)

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Action Requested by(*)

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Evaluation Criteria

1. AGE of Property?(*)

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Condition?

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Estimation or Source?

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2. ASSOCIATION with Individual(s)?

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Organization(s)?

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Historic Event(s)?

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3. ARCHITECTURE (if applicable)

Type of construction?

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Architect?

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Builder?

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5. LANDMARK

Do you or your association consider this property to be a landmark? Why?

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5. PHOTOGRAPHS (Maximum 8)

If applicable, must show total building, plus doors, windows and details.

File sizes cannot exceed 1MB.

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ADDITIONAL INFORMATION

Do you know of any other source ie. book, report, newspaper article or individual that has additional information about this property?

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Is there any other information that you feel is important and should be included?

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Application Prepared(*)

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Address(*)

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Phone (w)

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Phone (H)

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Email(*)

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Date(*)

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Signature

Sign Above

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Security check(*)

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